Rick Moran called, and now the mad scientist is in.

First and foremost: though I am a card-carrying scientist, and mad, I am neither an epidemiologist, a specialist in infectious disease, nor an expert in virology. I’m not even a physician. That said, I do have a few comments on The Washington Post’s front-page article titled “World Not Set To Deal With Flu” about which Rick wrote at Rightwing Nuthouse, and my take on the potential for a devastating avian influenza virus H5N1 pandemic. They are offered as a different look at the same info and not any argument that the avian flu problem somehow doesn’t deserve even more attention. I have written on this before, in fact, but from a different angle (see below).

Rick asks: “Am I being an alarmist? Am I overstating the potential for unmitigated disaster?”

Rick, I simply don’t know. (I wish I were an expert, and could say YES!) However, I do have a few questions about this Washington Post article and the way that the danger of pandemic was presented.

The biology of infectivity: From WaPo author David Brown:

If H5N1 never becomes easily transmissible in human beings, it will never become a pandemic. If it does become transmissible, the consequences are difficult to imagine.

These are big ifs. While both statements are undoubtedly true, they — in particular the former — only appeared at the midpoint of the article, somewhat dulling its impact following all the doom and gloom preceding them. To date, I believe there is no human-to-human infectivity documented. That doesn’t mean it hasn’t happened already. And researchers seem to be fairly sure that it will go that route. Still, it annoys me that the information was withheld for so long in the story.

Also, the mortality rate has been quoted as anywhere from 30% to 50% from this avian flu variant, and with a surprising number of “young, healthy adults” being affected. However, is this number misleading? I have read somewhere that many of the victims were from rural areas and/or were chicken farmers in second or third-world countries. Additionally, so comparatively few people have been reported as infected, that it seems premature to cite a proper mortality rate at all. It worries me in particular if the mortality rate is actually much lower than what’s been reported, for the reasons given in the WaPo article and summarized so well by Rick: if the virus makes people sick more often than it kills them, but still kills a significant proportion of infecteds, then it can survive longer and spread further in the population. In my view, we need more data, which unfortunately means that more people have to be reported as infected, sick, and/or dead.

Bogged down in bureaucracy: Given the way that bureaucracies operate, it is easy to see how the H5N1 bird flu problem could have missed the NIH’s top priority list, not to mention the World Health Org.’s, in recent years, precisely because of SARS — which seemed an acute, highly contagious, and very serious threat; and the perennial emphasis on HIV-AIDS, especially as it continues to devastate Africa. Let’s face it: there are only so many resources to go around, both financial and infrastructural, to combat health problems at all societal levels. Folks in high places have to make choices. Some choices prove to be wrong, but in retrospect, for all the right reasons at the time. Let’s hope that sufficient eyes are already opened.

The numbers: Think about it: 30-50 million dead in 1918 flu epidemic worldwide (some estimates go as high as 100 million; in the U.S.: ~675,000 perished) . That is staggering. The WaPo’s author, David Brown, couches it this way:

At least 50 million people, and possibly as many as 100 million, died when the world’s population was 1.9 billion people, one-third its current size.

which makes one want to instinctively extrapolate a similar proportion of dead — 150-300 million — if a new flu pandemic should occur. However, such a linear comparison seems to not take into account the great advances in medicine since the early 20th century. Indeed, while WHO may go with the high 300 million estimate, others, as Rick noted from News-Medical.Net, suggest 7 million and seem to base these numbers on projections from the more recent flu pandemics of 1957 and 1968. So I don’t know what numbers to believe, though any deaths from a pandemic are horrible and more could probably be done now regarding prevention and research. If the better-trusted numbers are the lower estimates of 7 million worldwide for a new avian flu pandemic, this could be a testament to the impressive advances in medical care and biomedical research over the last century. It could also be a reason why medical authorities seem paralyzed to make decisions until better estimates come in.

Vaccines and drugs: I’d written before on the lunacy of the Chinese authorities, who had allowed chicken farmers to treat chickens with the antiviral drug amantadine to try and prevent the H5N1 bird flu from spreading. This had allowed isolates of the virus to evolve and become largely immune to this drug. In David Brown’s article, he noted only one antiviral drug, oseltamivir, was useful to combat the virus. I wonder whether this is because of the selfish act on China’s part regarding amantadine.

Worse is the thought that adequate stockpiling and mass production of either antivirals or vaccine seem so improbable in the near term. However, you’re damned if you do and if you don’t, as we saw in the non-debacle debacle over flu vaccine last winter: first, there wasn’t enough, then there was, and then it wasn’t needed after all. Brown suggested rightly that the economics for flu vaccines and the drug industry are not conducive to the unpredictibility of the flu infection cycle. That there is now only a handful of an experimental vaccine available for potential widescale immunization is distressing.

I am not trying to de-emphasize the potential for a global pandemic, and I am not suggesting that the heat be taken off health officials worldwide regarding their apparent head-in-the-sand attitude to the potential for human-to-human transmission of a variant H5N1 strain capable of killing millions worldwide. I am trying to say that the WaPo report was a bit alarmist but was well-intended and important. I agree with Rick that this bird flu matter demands special attention in the MSM and alternative news sources, INCLUDING the A-list bloggers.

Said The MaryHunter @ 8:42 pm | Permalink   

1. One small addition to this excellent analysis.

   I linked to the CDC Bird Flu web page that states in fact there have indeed been 17 cases of confirmed human to human contact although it apparently was achieved through a similar type of contact of bird to human, i.e. direct contact with waste products.

   The kind of casual person to person contact that would lead to catastrophe
   has not been observed as yet.

   Comment by Rick Moran — 7/31/2005 @ 8:59 pm

---

2. […] MSM and alternative news sources, INCLUDING the A-list bloggers. 1 AUGUST UPDATE: Rick updates us that the CDC Bird Flu web page states th […]

   Pingback by TMH’s Bacon Bits » Blog Archive » Bird Flu H5N1 Pandemic: Cause For Alarum? — 8/1/2005 @ 4:41 am

---

RSS feed for comments on this post. TrackBack URI

Line and paragraph breaks automatic, website trumps email, HTML allowed: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <code> <em> <i> <strike> <strong>

Name (required)

Mail (will not be published) (required)

Website