Avian Flu: A Pandemic Threat to Humans or Just for the Birds??

Imagine a world where bodies pile up on streets, where transportation, communication and business activities halt, where police protection fails and where there are not enough doctors and nurses to care for tens of thousands of sick people. Are these images from a medical movie thriller?? Not at all. This was the situation in the United States and other nations during the 1918 flu pandemic that resulted in an estimated 50-100 million deaths worldwide. The fact is that another pandemic influenza could happen again, might cause as many as 180-360 million deaths globally and devastate families, economies and countries. The outbreak of avian flu cases in Southeast Asia, Turkey, Romania and other countries has caused widespread global concern. While human-to-human transmission has not yet appeared to have occurred, the prospect of a pandemic flu has become an urgent public health concern worldwide today. That is why all sectors of society across countries must work together to undertake pandemic influenza preparedness planning. These efforts will pay a dual dividend even if this H5N1 flu remains just for the birds because it will result in strengthened public health infrastructure and preparedness planning to respond to other flu and infectious disease outbreaks that may happen in the future. After all, with international travel and trade, our world is shrinking so that the spread of an infectious disease like avian flu, AIDS, and SARS is just a jet plane away. Since 1972, over 30 new infectious diseases have emerged and will continue to do so. Throughout history, these illnesses have been major killers and therefore, decisive shapers of history.

The triumph of public health interventions over the past 100 years including sanitation, hygiene, ensuring the safety of the food and water supply, and immunizations have resulted in as many as 20-25 of the 30 additional years of life expectancy for people in the developed world. In 2005, the marvels of modern medicine including antibiotics,new medications and the tools of molecular biology and information technology provide us with new weapons against disease. Yet, for many people in our world, life expectancy is less than it was in medieval times because of the impact of AIDS, malaria, TB and other infectious illnesses made all the worse because of lack of access to health care, education, medications and vaccines. That means that a disease that first develops in Asia or Africa where humans and animals live in close proximity, may spread rapidly across the globe unless we work to help the rest of the world build a public health infrastructure to prepare and prevent the spread of these illnesses.

There is an urgent need to marry the lessons of past public health achievements with new advances from science and technology to create innovative solutions to preventing and treating disease in our world where two million people cross national borders every day. H5N1 avian flu has served as a wakeup call to remind us of the challenges and devastation that a pandemic flu can cause but also provides unprecedented opportunities for prevention and advanced public health planning and preparedness to ensure a healthier future for people in the United States and globally.

The following interview was published in the Washington Post on January 4, 2006:

Prevention Is Key to Avian or Seasonal Flu

Wednesday, January 4, 2006; A15

Avian flu has recently moved to the top of President Bush's health care agenda. But medical experts such as Susan J. Blumenthal have been warning for years that international travel, a weakened public health system and antiquated vaccines have made the prospect of an influenza pandemic a matter of when, not if.

Blumenthal, a former assistant surgeon general, in a recent speech in Washington warned that the H5N1 strain of the virus, now confined largely to birds, has the potential to develop into a deadly human virus. Already, the virus has "killed more birds than any in the history of the world," humans do not have immunity, it is striking younger victims and it has spread rapidly into at least 16 countries, she said.

A clinical professor of psychiatry at Georgetown and Tufts University schools of medicine, Blumenthal was the first deputy assistant secretary for women's health, from 1993 to 1997, and is an authority on global public health. She retired from the government last year.

In an interview, she talked about infectious diseases and chronic illnesses -- and what individuals and the government can do to reduce risk. She said one of the lessons of Hurricane Katrina is that the United States is not sufficiently prepared to deal with any number of crises, from a terrorist attack to a natural disaster to a pandemic.

-- Ceci Connolly

Q Why is a pandemic a matter of when, not if?

AEach generation has had a pandemic. The 1918 influenza pandemic killed 40 million people and infected 500 million. It was like a global blizzard over 18 months. With international trade and modern travel, the world is shrinking. . . . In 1969, the surgeon general announced the "war against infectious diseases is over." We thought we had conquered the microbe. But we've had 30 new diseases since 1972, including SARS [severe acute respiratory syndrome], monkey pox and Lyme disease.

How real is the threat of an avian flu pandemic?

On the question of are we more vulnerable, there is the group of people I call the ostriches and the Chicken Little. The ostriches point out that we have better science and public health than ever before, that we have not seen the H5N1 virus here. The Chicken Little say we do not have enough antiviral [medications]; we don't have a vaccine. The threat is probably somewhere in between.

How is the virus spread?

It begins in aquatic birds, moves to domestic poultry and then potentially to humans. . . . Asia is a hotbed [for H5N1] because people live in close proximity to poultry, and they lack a strong public health infrastructure. You can become infected through direct contact with poultry or contact with a surface that has poultry droppings or excretions. There have been about 135 human cases since 1997, which is relatively few.

Your speeches are alarming. Is that intentional?

Somewhat. If you give candid information, people make good decisions. But we also want it to be a wake-up call. People know they should eat right, exercise, get out of the way of a hurricane, but we don't always do those things. We know we shouldn't smoke, yet one out of five people do. It took Katrina and seeing some of the failures in not having state, federal and local preparedness not being coordinated to serve as a wake-up call to the concern of pandemic flu.

Are we prepared?

We're not sufficiently prepared if a pandemic were to strike us this year. We have a plan that outlines the major steps to be taken. Hopefully we'll have the time to develop new vaccines and stockpile antivirals. We don't have [the necessary] communications systems in place. We don't have a rapid diagnostic tool for using in the field, there is no cell-based vaccine nor the production systems that would be needed. . . . But we can't forget the [pandemics] that are currently with us.

Such as?

Forty million people worldwide are infected with the AIDS virus; 3 million die each year. One million children die of measles each year because they don't get a 70-cent vaccine. . . . In the United States, we have the highest infant mortality rate of the industrialized world. We spend twice as much as any other nation on health care, and we rank 18th in life expectancy and 35th in overall health status.

If there is an outbreak of avian flu, would there be a quarantine in the United States, and what would it look like?

What we would suggest is social distancing -- have people stay in their homes, not go to mass gatherings. It would be a real challenge. We have a generation of physicians who haven't trained in quarantine techniques. During the SARS outbreak, it was health care professionals and students who violated the quarantine. If there is a pandemic, things could quickly degenerate into chaos. That's why it's important to rehearse for these things.

What should average Americans do to protect themselves against avian flu or other infectious diseases?

Get your seasonal flu shot. The seasonal flu causes 36,000 deaths in America and 500,000 worldwide. It translates into $37 billion in economic costs related to treatment. . . . Also get a pneumonia shot. Practice good hygiene, particularly around the holiday season when you are at a lot of parties shaking hands. Washing hands is one of the best public health interventions we have.

What would you put on the top of a public health agenda for 2006?

Smoking, certainly. If you thought there were a killer out there claiming the lives of one out of every five people, we'd have the FBI, CIA and police all out there tracking that terrorist. . . . Safe water. Water is one of the key health and political issues of the 21st century. [Unclean] water is the leading cause of death and disability in the world. Water impacts the economy; it's linked to energy, recreation, food. Katrina showed the importance of access to safe water. Sixty-five percent of our bodies are water.

You say in your speeches that we are a treatment-oriented society rather than a prevention-oriented society. Why is that noteworthy?

Small steps can bring big rewards. Losing five or 10 pounds can make you feel much better. Walking 10,000 steps a day. These can significantly decrease your risk for chronic illnesses. . . . On a public policy level, whether you're trying to prevent cancer, diabetes, a hurricane or bioterrorism, prevention is the cornerstone.