Thursday, December 23, 2004


This way to the apocalypse!

Here comes Captain Trips!
Scary scenario: Pandemic

By Anita Manning, USA TODAY

Imagine showing up to work one day and finding half your co-workers out sick. Imagine the business world in slow motion, healthy workers overburdened by taking on the jobs of the sick, hospitals overflowing with patients, schools closed and not enough medicine to go around.

That's an apocalyptic vision of what could burst out of a smoldering bird flu outbreak that has spread across Asia, threatening to turn into a global epidemic of flu: a pandemic.

Scientists long have expected another flu pandemic, the kind of wildfire epidemic that emerges every few decades. Nobody knows when it will happen or how bad it could be.

Plans are being made to handle what could be a public health nightmare, but "much of the world is unprepared for a pandemic of any size," the World Health Organization says.

An Institute of Medicine report, "The Threat of Pandemic Influenza," last month estimated that in a worst-case scenario, up to 207,000 people could die of the flu in the USA along with 733,000 hospitalizations and 42 million people treated as outpatients. By comparison, an average flu season claims 36,000 lives and results in 200,000 hospitalizations.

Last week, health experts from the USA, Europe, Asia, Australia and New Zealand gathered at WHO's Geneva headquarters to take part in the latest of a series of meetings that have been held all year to plan for dealing with the next flu pandemic.

Pandemic flu is a flu strain that is new, deadly and contagious. Flu viruses change in minor ways every year in a process scientists call antigenic drift, which is why new flu vaccines are needed each year. For instance, the predominant strain this season is called A (H3N2) Fujian. It is slightly different from the A (H3N2) Panama that circulated in 2000-2001, but because these viruses have been around in humans for years, the population has a degree of immunity.

But every few decades a big change occurs, called an antigenic shift, that results in a completely new flu strain.

Now, the strain that has world health experts most concerned is a bird flu, called A (H5N2), that has spread across Asia and has jumped from chickens into humans.

It has killed tens of millions of chickens, and hundreds of millions more have been slaughtered to contain the spread of virus. Ominously, it has been detected in other species, including cats, pigs and wild birds. It also has infected 44 people since January, killing 32 this year.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), says the fact that only 44 people have been known to be infected is good news, because it means the disease doesn't spread easily. "The really bad news," he says, "is the mortality rate," which is more than 70%, compared with fewer than 1% who die of flu annually.

There may be undetected, milder cases in humans. On Wednesday, Reuters reports, Japanese health officials said tests show that one poultry worker tested positive for avian flu, although he had no symptoms.

What worries Fauci and other health experts is the possibility that the avian flu and a human flu strain could occur in the same person or animal, swap genes and create a monster.

Klaus Stohr, coordinator of WHO's Global Influenza Programme, says many questions remain unanswered about avian flu, how it infects people and what happens when it does.

"We don't know how many people are going to be affected, but we know if we are badly prepared, the damage will be much bigger."

Some people say health experts are being needlessly alarmist.

"If all goes according to the most dire predictions, it could be devastating," says Gilbert Ross, a medical doctor and executive director of the American Council on Science and Health, a consumer education group that frequently calls attention to what it sees as health scares. "But the chance of all this occurring is small."

In an editorial in the National Review Online, Ross wrote: "It's a good idea to be prepared as the recent scarcity of flu vaccine has demonstrated, but the dire warnings about billions sick and millions dead from an onrushing bird-flu pandemic seem overblown, to say the least."

Predictions about flu are difficult to make, says William Schaffner of Vanderbilt University, an expert in infectious diseases. But "true influenza immunologists say it's not a matter of whether, it's a matter of when."

The U.S. Department of Health and Human Services published its draft pandemic preparedness plan in August. It notes that antivirals are being stockpiled, surveillance and lab capacity increased and research on viruses and vaccines is being expanded.

Experimental avian flu vaccines are being developed by Aventis and Chiron under contracts from NIAID, Fauci says, and new methods of making vaccines are under investigation.

Production of pilot lots of up to 10,000 doses is to be finished by the end of the month, and clinical trials will start soon, he says.

Health and Human Services also agreed to buy 2 million doses of vaccine from Aventis, which will give the company experience in making large quantities.

It all costs money, and HHS has increased its funding for flu-related activities from $39 million in 2001 to a projected $283 million next year.

Health experts say that when the pandemic comes, it won't happen overnight.

"We believe there will be different phases," Stohr says. "It will not start immediately with a full-blown, fully transmissible pandemic virus."

Response plans are designed to ratchet up as the pandemic develops, moving from steps that might include school closings or travel restrictions to increased vaccine production and antiviral distribution. "We don't expect it this year," Fauci says. "It's extremely unlikely."

Could it come next year? "Yeah," he says. "We're due for it."
Of course, thanks to the Bush Administration's compassionate concern for all Americans, and their needle-sharp attention to detail, not to mention their eagle-eye competence, there are more than enough flu shots to go around...
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