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October 5, 2005

Bush may use troops, quarantine if bird flu breaks out: Doesn't he really mean WHEN it breaks out?

Topics: Health Issues

Based on historical patterns, influenza pandemics can be expected to occur, on average, three to four times each century when new virus subtypes emerge and are readily transmitted from person to person. However, the occurrence of influenza pandemics is unpredictable. In the 20th century, the great influenza pandemic of 1918-1919, which caused an estimated 40 to 50 million deaths worldwide, was followed by pandemics in 1957-1958 and 1968-1969.

Experts agree that another influenza pandemic is inevitable and possibly imminent. (WHO Report, 15 January, 2004)

So what the Seattle Times article headline SHOULD say is WHEN the bird flu breaks out, and what all of us SHOULD BE ASKING, is why has our country taken so long to get serious about avian influenza! After all, it's been a long time coming, and it's shown no signs of attenuation. And please believe me, we are not ready for it!

From the Seattle Times: President Bush said yesterday that he is considering the use of military troops to impose a quarantine in the event of a deadly flu pandemic.

Bush, in response to a question at a news conference, echoed warnings from health experts who fear a replay of the 1918 pandemic that killed an estimated 50 million people worldwide. He outlined a series of steps to deal with an illness that could overwhelm the health-care system.

In a post I wrote on January 22, as in several previous posts and several since then, I warned that the Avian influenza is continuing to increase in frequency of outbreaks (some internal links in older posts may be broken - we've changed URL's since then). In that same post I wrote that WHO was concerned that it could become a global epidemic (pandemic), and that we should be aware that avian influenza(bird flu) kills people, and lots of them. I also provided comments from the CDC that warned:
"If these H5N1 viruses gain the ability for efficient and sustained transmission between humans, there is little preexisting natural immunity to H5N1 in the human population, and an influenza pandemic could result, with high rates of illness and death."
In a January 25th post I wrote that the virus had already recombined and was capable of transmitting human to human fatal infections under the appropriate conditions, such as close contact during the care of infected patients," and further commented that, "This stuff is about as serious as a heart attack, but it spreads, and it spreads, and it spreads. That's the makings of the pandemic WHO is worried about."

Why was I so concerned that far back? One reason was that we were already, at that point in time, dealing with "old news."

Recombinomics - September 28, 2004

The "documentation of human-to-human transmission in this situation is better than it has been in previous cases."

The above is the key statement in the report below. It is unlikely that this is the first H5N1 human to human transmission. It is just the one with the strongest epidemiological data because the mother was in Bangkok, when the daughter became ill in northern Thailand. The key epidemiological fact in this case and the cluster in southern Vietnam in late July / early August was the fact that the relative/care-giver developed symptoms 1-2 weeks after the initial case.

The publicly available sequences of chicken isolates from southern Vietnam associated withe the Vietnamese cluster were virtually identical to the isolates from the beginning of this year.

In Vietnam and Thailand in particular, the isolates have polymorphisms not found in other H5N1 isolates. However, these polymorphisms are found in other mammalian isolates such as H1N2. Thus the virus has already recombined and is capable of transmitting human to human fatal infections under the appropriate conditions, such as close contact during the care of infected patients.

Another reason for concern, long before the MSM began to give the story the increased attention that it deserved, was that I had already read and posted on a December 10 article in "The Age," in which they reported China's concern over potential epidemic of avian influenza, and that Chinese health officials were drawing up plans to deal with a pandemic as the World Health Organisation warned that flu spread from birds to humans could kill up to 100 million before a vaccine is ready.

Other indications were compounding my concern - as I noted in my December 10 post.

The following abstract from the research journal "Enferm Infecc Microbiol Clin. 2004 Aug-Sep;22(7):412-8, describes the situation as of Sept 04":

Avian influenza affects most types of birds and occurs in epidemics on poultry farms. The fatal disease is named "highly pathogenic avian influenza" and is caused by influenza A virus subtypes H5 and H7. The natural reservoir is the migratory waterfowl that occasionally infects domestic poultry. In 1997 in Hong Kong, 18 persons were infected and 6 of them died. At the end of 2003 and the beginning of 2004, avian influenza H5N1 infected numerous farms in several South-Eastern Asian countries. The virus was transmitted to humans in close contact with infected birds. A total of 34 persons were infected and 23 of them died. There is currently a considerable concern about the H5N1 avian influenza that has infected humans: the high virulence, evolution rate, the possibility of recombination with other influenza viruses, how H5N1 variants that infect humans or different approaches to the development of influenza vaccines. Source - PMID: 15355771(PubMed I.D.#).

As though this wasn't enough to cause us concern - back then, according to "Proc Natl Acad Sci U S A. 2004 May 25;101(21):8156-61. Epub 2004 May 17," the hemagglutinin of recent human isolates has undergone significant antigenic drift. Like the 1997 human H5N1 isolates, the 2003 human H5N1 isolates induced the overproduction of proinflammatory cytokines by primary human macrophages in vitro, whereas the precursor H5N1 viruses and other H5N1 reassortants isolated in 2001 did not.

This acquisition by the viruses of characteristics that enhance virulence in humans and waterfowl and their potential for wider distribution by infected migrating birds (unlike the precursor H5N1 viruses and other H5N1 reassortants of 2001) are causes for renewed pandemic concern.

At that time, I predicted that we were going to hear much more about avian influenza in the near future. The future is almost here, and we are definately not ready for it!

So why are we only now begining to get serious about this deadly threat to the entire planet? More importantly, WHEN are we going to get ready for avian influenza, and WHY are we thinking about troops and quarantines? Shouldn't we be working on vaccine development and availability, as well as stockpiles of appropriate antivirals?

The answer doesn't involve any government conspiracy to keep us in the dark, rather, it involves a media that's been concentrating on what I regard as frivolous and agenda-driven issues at the cost of public awareness of an emerging slaughter of human beings by a virus called H5N1. So it's time for the public to become a vociferous wave demanding attention to solving addressing and solving the problem.

So are we going to start speaking out, or are we going to wait patiently and quietly for death to take us and our loved ones, without a fight?

One little problem: Four different influenza antiviral drugs (amantadine, rimantadine, oseltamivir, and zanamivir) are approved by the U.S. Food and Drug Administration (FDA) for the treatment and/or prophylaxis of influenza. All four have activity against influenza A viruses. However, sometimes influenza strains can become resistant to these drugs, and therefore the drugs may not always be effective.

Then there's this: Analysis of a key protein in different subtypes of avian flu viruses shows that resistance to the antiviral drug amantadine in H5N1 occurs worldwide.

And resistance to rimantadine is now also spreading in H5N1.

Do we have sufficient stockpiles of antiviral drugs that ARE affective against H5N1? I don't think you want to bet your life on it!

CDC - Information About Influenza Pandemics

Posted by Richard at October 5, 2005 12:56 PM

Concerning the lack of planning on the part of the government and the fact that there are not enough vacinations to go around, I am suprised no minority leaders have brought up the fact that probably the rich, whites will get all the shots and the poor minorities won't. Another case like the New Orleans hurricane relief efforts. It appears that the government is hoping that the poor minorities will be killed off in the avian flu pandemic.

Posted by: pamy at October 5, 2005 3:30 PM

To add just a little more information to the mix, two different teams have managed to resurect and sequence the virus that caysed the 1918 pandemic, and wouldn't you know, it was a bird flu. The reserchers identified between 25-30 base pair changes that resulted in the virus becoming a killer. The H5N1 strains that are circulating now share about half of them.

Posted by: Rorschach at October 6, 2005 9:40 AM

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