Avian flu update: autumn in Indonesia

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Could the outbreak of the H5N1 virus (avian flu or bird flu) in 57 people in Indonesia be the harbinger of the global pandemic that has had experts throughout the world very concerned for years?

Let’s hope not, but this community of scientists, researchers and doctors is watching developments very closely and holding their breath. At stake, literally, are millions of lives around the world including, by one conservative estimate, 1.7 million in the U.S. (Note: my day job puts me in contact with people who have to concern themselves with projecting this risk, and I’ve helped write articles on this topic for risk management publications. I’ve posted on this subject in this blog here, here and here.)

You can read those posts for an overview, or do your own research (there’s plenty of it out there now) or visit this blog which is aggregating the latest details and research on a daily basis. Here, however, are the pertinent details:

The reason the H5N1 virus has created so much concern is because it is genetically very similar to the virus that created the famous 1918 Spanish Flu pandemic that is generally believed to have killed between 20 and 40 million people world-wide (one modern estimate puts the total at 100 million, however). The impact today could be even more devastating considering the world is much more densely populated now and people are many times more mobile, which could promote the rapid spread of the pandemic.

Despite the genetic similarity, an H5N1 vaccine has yet to be developed. The flu has already killed millions of birds in Asia, and led to the preventive slaughter of millions more domestic fowl. So far – and this is important – the virus has passed to humans only through animal to human contact; it has yet to take a form that allows it to pass from human to human (more potentially good news on this this in a few more paragraphs). Flu viruses, however, are very unstable and mutate easily; every influenza that affects humans – such as the strains that appear annually – began in animals and followed this path. The easiest way for the virus to mutate is to come in contact with a human or animal that already has another strain of influenza active in its body and for the two viruses to become recombinant. (Pigs, for example, have been shown to be able to host both H5N1 and “human” influenza and H5N1 has started to turn up in pigs and tigers in Asia.)

H5N1 infection so far have been mainly in Southeast Asia where many people live and work in close proximity to birds and other animals susceptible to being carriers. Approximately 40 percent of people who have contracted the virus have died.

Here’s why the current cases in Indonesia are significant: Indonesia, unlike other asian countries, refrained from wholesale slaughter of commercial and domestic flocks of poultry thought to be harboring the virus, which might explain the outbreak. While there is still no confirmation of human-to-human transmission, the number of people infected there within a short timeframe is troubling. Also, this spring there were several small outbreaks in Vietnam in “pods” of people. The course of the Spanish Flu was for a few isolated cases in the spring, followed by a quiet summer and then a rapid spread the in the fall.

On a bit more positive note, some virologists think there may be some natural barriers keeping the virus at bay in humans, as noted here:

  1. Its viral replication in human cells may be inefficient. There may be too few viral offspring emerging from infected cells to create a big “viral load” that can be spread through coughing or sneezing, as the human flu virus does so well.
  2. The avian virus is unable to lock on effectively to human cells, or more accurately certain types of human cells. The spike that enables it to lock on to the cell receptor is the wrong shape.
  3. Avian viruses’ natural home is the gut of birds, where the temperature is a balmy 37 degrees Celsius. The human respiratory tract, though, is 33 degrees to 34 degrees Celsius. That coolness could have an impact on how well the virus reproduces.
  4. Bird viruses are well adapted to evading the immune system of birds by skirting the molecular tripwires that unleash antibodies and white blood cells that destroy invaders. But they do not yet have this in humans.

This may be good news, but the spread of H5N1 to species other than birds (again, documented in pigs and tigers), and the ability of other influenza strains to make the jump to humans, still raises major concerns.

For a comprehensive look at the havoc a pandemic could create medically, politically and economically, and what can be done to reduce the risks and ultimate impact, I highly recommend you read this article by Dr. Michael Osterholm. Just because the risk is almost mind-bogglingly surreal to consider doesn’t mean it can’t happen. After all, a year ago how many people could have conceived of a tsunami big enough to devastate half a dozen countries, or a hurricane wiping out 80 percent of a major metropolitan area in the U.S.?

Update:

Here’s a report from CNN that suggests that H5N1 is resistant to Tamiflu (oseltamivir), the leading antiviral drug that countries are trying to stockpile as a first line of defense until a vaccine can be developed.

Also, Senator Bill Frist weighs in. A key quote from his Op-Ed:

If a pandemic occurs soon, we will be in a race against time to build the appropriate defenses on the fly. We cannot afford inaction. Through the Project Bioshield legislation President Bush signed last year, we began the process of preparing for biological, chemical and nuclear threats. But Congress and the administration still need to do much more.

The avian flu poses a serious risk to our nation’s health and security. Every medical worker, public health specialist, parent, and, indeed, every citizen, needs to think about how we can confront it. Right now, preparing to face a pandemic should rank very high among our nation’s priorities. And, for the safety of its people, our nation needs to act now.

(HT: Avian Flu – What We Need to Know)

28 thoughts on “Avian flu update: autumn in Indonesia”

  2. One would like to think so. We’re in an age where we take it for granted that there’s got to be a pill to fix practically everything. This is not always the case, and the nature of this virus and the way it spreads is pretty scary.

    The concern is that this virus attacks the body very quickly and essentially causes the body to attack itself (I can’t think of the term for this right now, auto-something). People can be beyond help within 48 to 72 hours. Also, if it follows the 1918 form, it strikes the healthiest people hardest. Projections are that about 50% of mortalities will be in the ages 15 to 45 – quite unlike most viruses where the very young and very old are most at risk (there’s a table showing projected mortality by age in the article I mentioned above that I helped out on.) This could mean that people who are normally quite healthy will discount the initial symptoms until it’s too late.

  3. I need to adjust my comments preferences to allow longer entries, but for now I’ll just breakthings up into a series.

    Regarding our “advanced” technology and medicine: virus vaccine testing and development is still being done using 1950s era egg technology. There’s been no financial incentive to develop better techniques, at least, not compared to making smaller and smaller iPods. Here’s another interesting point: ventilators are used to help victims of severe flu breathe in hospitals, but I’m told that there are not enough ventilators for every hospital in the U.S. and that hospitals share them. There is only one company in the world that makes these ventilators (in France, I think they said). Demand will quickly outstrip supply … and that is in the advanced U.S. What will happen in large parts of Asia and the so-called Third World?

  4. The U.S. and other countries are stockpiling Tamiflu, which is kind of a universal vaccine. It may be generally effective, but no one is sure how it will work until the virus takes it’s mutated form. As you probably know, if the virus isn’t completely knocked by Tamiflu, it could mutate further into an even more resistant strain. Oh, and I think there is only something like 220 million doses of Tamiflu on hand right now (I believe that’s the number – it’s late and my brain is a little fuzzy, but that is in my notes somewhere). A specific vaccine for whatever form H5N1 takes will take some time to develop after the human-to-human strain appears.

    My, I’m a load of laughs tonight, aren’t I? Oh well, might as well tell you that a report that came out from the World Health Organization a day or two ago projects as many as 100 million deaths world-wide. There’s other details in the report that sound better; you can probably find out more on Fox or CNN, or go to the WHO web page. And again, check out the links within the post for more details. It’s not all doom and gloom, but this is a huge challenge and an ultimate solution requires not just money and technology, but unprecedented cooperation globally in sharing information, in quickly identifying and controlling outbreaks and working madly to enhance our capabilities before the pandemic emerges. And prayer, my friend, prayer. Prayer for more time, for favor and breakthroughs, even for deliverance and healing, at whatever level you can muster the faith.

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