I'm guessing this is way too long for you to read.
Infectious diseases remain the number one killer of humans worldwide. Currently, more than 39 million people live with HIV, and last year about 2.9 million people died of AIDS, bringing the cumulative total of deaths from AIDS to approximately 25 million. Tuberculosis (TB) and malaria also remain major causes of death. In 2003, about 8.8 million people became infected with TB, and the disease killed more than 2 million. Each year, malaria causes more than 1 million deaths and close to 5 billion episodes of clinical illness. In addition, newly emerging infections, diarrheal and other vector-borne diseases, and agents resistant to antibiotics pose a serious and growing public health concern.
Given so many other significant infectious diseases, why does another influenza pandemic merit unique and urgent attention? First, of the more than 1,500 microbes known to cause disease in humans, influenza continues to be the king in terms of overall mortality. Even in a year when only the garden-variety strains circulate, an estimated 1-1.5 million people worldwide die from influenza infections or related complications. In a pandemic lasting 12 to 36 months, the number of cases and deaths would rise dramatically.
Recent clinical, epidemiological, and laboratory evidence suggests that the impact of a pandemic caused by the current H5N1 strain would be similar to that of the 1918-19 pandemic. More than half of the people killed in that pandemic were 18 to 40 years old and largely healthy. If 1918-19 mortality data are extrapolated to the current U.S. population, 1.7 million people could die, half of them between the ages of 18 and 40. Globally, those same estimates yield 180-360 million deaths, more than five times the cumulative number of documented AIDS deaths. In 1918-19, most deaths were caused by a virus-induced response of the victim's immune system -- a cytokine storm -- which led to acute respiratory distress syndrome (ARDS). In other words, in the process of fighting the disease, a person's immune system severely damaged the lungs, resulting in death. Victims of H5N1 have also suffered from cytokine storms, and the world is not much better prepared to treat millions of cases of ARDS today than it was 85 years ago. In the 1957-58 and 1968-69 pandemics, the primary cause of death was secondary bacterial pneumonias that infected lungs weakened by influenza. Although such bacterial infections can often be treated by antibiotics, these drugs would be either unavailable or in short supply for much of the global population during a pandemic.
The arrival of a pandemic influenza would trigger a reaction that would change the world overnight. A vaccine would not be available for a number of months after the pandemic started, and there are very limited stockpiles of antiviral drugs. Plus, only a few privileged areas of the world have access to vaccine-production facilities. Foreign trade and travel would be reduced or even ended in an attempt to stop the virus from entering new countries -- even though such efforts would probably fail given the infectiousness of influenza and the volume of illegal crossings that occur at most borders. It is likely that transportation would also be significantly curtailed domestically, as smaller communities sought to keep the disease contained. The world relies on the speedy distribution of products such as food and replacement parts for equipment. Global, regional, and national economies would come to an abrupt halt -- something that has never happened due to HIV, malaria, or TB despite their dramatic impact on the developing world.
The closest the world has come to this scenario in modern times was the SARS (severe acute respiratory syndrome) crisis of 2003. Over a period of five months, about 8,000 people were infected by a novel human coronavirus. About ten percent of them died. The virus apparently spread to humans when infected animals were sold and slaughtered in unsanitary and crowded markets in China's Guangdong Province. Although the transmission rate of SARS paled in comparison to that of influenza, it demonstrated how quickly such an infectious agent can circle the globe, given the ease and frequency of international travel. Once SARS emerged in rural China, it spread to five countries within 24 hours and to 30 countries on six continents within several months.
The SARS experience teaches a critical lesson about the potential global response to a pandemic influenza. Even with the relatively low number of deaths it caused compared to other infectious diseases, SARS had a powerful negative psychological impact on the populations of many countries. In a recent analysis of the epidemic, the National Academy of Science's Institute of Medicine concluded: "The relatively high case-fatality rate, the identification of super-spreaders, the newness of the disease, the speed of its global spread, and public uncertainty about the ability to control its spread may have contributed to the public's alarm. This alarm, in turn, may have led to the behavior that exacerbated the economic blows to the travel and tourism industries of the countries with the highest number of cases."
SARS provided a taste of the impact a killer influenza pandemic would have on the global economy. Jong-Wha Lee, of Korea University, and Warwick McKibbin, of the Australian National University, estimated the economic impact of the six-month SARS epidemic on the Asia-Pacific region at about $40 billion. In Canada, 438 people were infected and 43 died after an infected person traveled from Hong Kong to Toronto, and the Canadian Tourism Commission estimated that the epidemic cost the nation's economy $419 million. The Ontario health minister estimated that SARS cost the province's health-care system about $763 million, money that was spent, in part, on special SARS clinics and supplies to protect health-care workers. The SARS outbreak also had a substantial impact on the global airline industry. After the disease hit in 2003, flights in the Asia-Pacific area decreased by 45 percent from the year before. During the outbreak, the number of flights between Hong Kong and the United States fell 69 percent. And this impact would pale in comparison to that of a 12- to 36-month worldwide influenza pandemic.
The SARS epidemic also raises questions about how prepared governments are to address a prolonged infectious-disease crisis -- particularly governments that are already unstable. Seton Hall University's Yanzhong Huang concluded that the SARS epidemic created the most severe social or political crisis encountered by China's leadership since the 1989 Tiananmen crackdown. China's problems probably resulted less from SARS' public health impact than from the government's failed effort to allay panic by withholding information about the disease from the Chinese people. The effort backfired. During the crisis, Chinese Premier Wen Jiabao pointed out in a cabinet meeting on the epidemic that "the health and security of the people, overall state of reform, development, and stability, and China's national interest and image are at stake." But Huang believes that "a fatal period of hesitation regarding information-sharing and action spawned anxiety, panic, and rumor-mongering across the country and undermined the government's efforts to create a milder image of itself in the international arena."
Widespread infection and economic collapse can destabilize a government; blame for failing to deal effectively with a pandemic can cripple a government. This holds even more for an influenza pandemic. In the event of a pandemic influenza, the level of panic witnessed during the SARS crisis could spiral out of control as illnesses and deaths continued to mount over months and months. Unfortunately, the public is often indifferent to initial warnings about impending infectious-disease crises -- as with HIV, for example. Indifference becomes fear only after the catastrophe hits, when it is already too late to implement preventive or control measures.
Thanks for the "chicken little" report - I've been hearing the same crap for 40 years - guess what - no pandemic plagues. Just a little of natures pruning.