Officials race to head off a bird flu pandemic


Maybe it's just media influence but I am fucking scared about this. Why is the world always ending? I'm sick of worrying. I don't even know what to say about the 20,000 human beings that were killed by this monstrous earthquake. What can you say when life in the U.S. is so normal right now and we can't even grasp that level of death? How could we anyway? I just don't know how to reconcile by day-to-day life with the catastrophes of the world. What's more important?




Officials race to head off a bird flu pandemic
By Steve Sternberg, USA TODAY
Health officials from all over the world are scrambling to figure out how to ward off a global outbreak of deadly flu. President Bush, fresh from reading a 546-page tome on his vacation about the 1918 "Spanish flu" outbreak, has been consulting with the heads of vaccine companies, and he warns that the military might be used to enforce quarantines. His administration's flu battle plan reportedly predicts that almost 2 million Americans could die in a major outbreak. (Related: Tracking a deadly virus)
Disinfectant is sprayed at a chicken farm in Yeoncheon, north of Seoul. South Korea is advising farmers to take precautions against a potential bird flu outbreak.
By Ahn Chung-hwan, AP

The dire projections are prompting new anxiety among Americans already reeling from hurricane disasters. But the experts have been warning for years about a possible flu pandemic. Why suddenly are all the government's alarm bells going off? Are there real reasons to be frightened now? And if there is a flu pandemic, how bad could it be?

Two recent, unrelated events have put the possibility of a flu pandemic into sharp focus:

•An avian flu that had largely been confined to Southeast Asia has spread to Europe and Turkey.

•Two back-to-back hurricanes in the Gulf demonstrated nature's potential for devastation.

Secretary of Health and Human Services Michael Leavitt was visiting hurricane emergency shelters after Katrina and Rita when it hit him just how bad a flu pandemic could be. "What if it weren't just New Orleans" struck by catastrophe, Leavitt recalls thinking. "What if it were Seattle, San Diego, Corpus Christi, Denver, Chicago, New York? Make your own list."

Unlike a hurricane that's confined to a specific area over a short time, a pandemic flu strikes everywhere and can last a year or more, says Leavitt, who left Saturday on a fact-finding trip to flu-stricken regions of Southeast Asia. Waves of illness would shutter schools and businesses, swamp hospitals and send tens of thousands to overflow medical shelters and early graves.

"The big lesson I learned from Hurricane Katrina is that we have to be thinking about the unthinkable," Leavitt says, "because sometimes the unthinkable happens."

The unthinkable has become all too real in Vietnam, Thailand and other Asian countries where an especially deadly flu virus, influenza A/H5N1, has been spreading through millions of birds for the past two years. The virus recently has shown up in birds in Romania, Russia and Turkey.

So far, the virus has infected 117 people, killing 60, a death rate of nearly 50%. Most people have been infected through close contact with infected poultry. In rare cases, the virus is believed to have spread among family members through close contact. If the virus learns to spread readily from person to person through the air, it could cause a pandemic that rivals the worst.

No one can predict when a killer flu will strike, how bad it will be or even whether the virus will sustain its virulence after it begins to spread widely among humans. "It's clear the warning signs are troubling, but there is no certainty," Leavitt says.

The 'ugly truth'
A SCARY SCENARIO
The last flu pandemic, the Hong Kong flu, struck in 1968-69 and killed 1 million people worldwide and 34,000 people in the USA. A strain three times more lethal could kill more than half a million in the USA and send 2 million people to the hospital. Projected numbers of dead, hospitalized and cases:
State Dead In hospitals No. of cases
Ala. 8,886 38,591 1,079,789
Alaska 886 4,558 152,328
Ariz. 9,223 39,675 1,138,742
Ark. 5,350 22,660 630,705
Calif. 60,875 273,090 8,067,075
Colo. 7,192 32,978 973,161
Conn. 7,054 29,932 817,465
Del. 1,507 6,560 182,895
D.C. 1,155 4,974 132,241
Fla. 35,737 142,386 3,663,486
Ga. 13,655 62,912 1,871,561
Hawaii 2,446 10,571 296,651
Idaho 2,279 10,157 302,558
Ill. 23,720 103,738 2,973,962
Ind. 11,817 51,711 1,466,027
Iowa 6,233 26,090 713,106
Kan. 5,373 22,946 654,335
Ky. 7,930 34,748 977,031
La. 8,334 37,148 1,087,942
Maine 2,651 11,333 310,513
Md. 9,958 44,500 1,273,572
Mass. 13,136 56,038 1,529,313
Mich. 19,622 86,005 2,443,473
Minn. 9,304 40,786 1,171,387
Miss. 5,362 23,531 682,625
Mo. 11,274 48,240 1,350,515
Mont. 1,804 7,787 219,703
Neb. 3,441 14,697 414,218
Nev. 3,243 14,455 419,202
N.H. 2,333 10,301 293,177
N.J. 16,980 72,791 2,013,212
N.M. 3,244 14,504 432,438
N.Y. 37,701 162,490 4,534,307
N.C. 14,987 65,637 1,856,296
N.D. 1,371 5,795 160,221
Ohio 23,197 99,979 2,796,583
Okla. 6,833 29,376 829,273
Ore. 6,724 29,047 810,872
Pa. 27,185 112,658 3,004,915
R.I. 2,234 9,263 246,857
S.C. 7,474 32,983 940,045
S.D. 1,559 6,599 184,493
Tenn. 10,875 47,678 1,342,050
Texas 35,124 160,648 4,859,834
Utah 3,393 15,906 514,787
Vt. 1,185 5,213 147,245
Va. 13,104 58,872 1,683,499
Wash. 10,910 48,610 1,402,591
W.Va. 4,049 17,014 453,947
Wis. 10,620 45,842 1,292,419
Wyo. 915 4,086 119,936
Note: Numbers are based U.S. Census data, a Centers for Disease Control and Prevention computer program and a 25% infection rate.
Source: The Trust for America's Health, a non-profit public health advocacy group

Health experts agree that a pandemic is inevitable sometime, that the best defense is preparedness and that the world isn't ready. Katrina laid bare America's inability to deal with a massive emergency.

"We're not prepared. It's the ugly truth," says Shelley Hearne, executive director of Trust for America's Health, a non-profit public health advocacy group. "If our emergency response failed so badly for a Category 5 hurricane, imagine what would happen if a Category 5 viral storm hit every state."

Among other things, she says, there is no human vaccine against the avian flu virus, the U.S. government has stockpiled enough anti-viral drugs to treat only 1% of the population, and the hospital system couldn't handle the overload if flu victims flooded emergency rooms.

Health experts such as Hearne have been sounding the alarm about a possible flu pandemic for at least two years, but their cries went largely unheeded until now.

Katrina hit just days after Bush finished John M. Barry's The Great Influenza: The Epic Story of the Deadliest Plague in History during his August vacation on his ranch, White House spokesman Scott McClellan says.

Apparently motivated by the frightening tale of the 1918 epidemic, which killed an estimated 150,000 people in the USA and 50 million worldwide, Bush said last week that the military might be needed to enforce quarantines.

Michael Stebbins of the Federation of American Scientists and others challenged the suggestion as unworkable. "It shows a fundamental lack of understanding of public health emergencies," he says. "I would be fascinated to see whether the president has a plan to quarantine a city like Washington, D.C., New York or Boston with so many roads in or out. Is he going to send in tanks and armed men?"

Assistant Secretary of Defense William Winkenwirder declined to comment on the president's statement but said the military is often called upon for logistical and medical support in emergencies.

Scientific reports released on the heels of Bush's statement increased the nation's anxiety. In one, Jeffery Taubenberger of the Armed Forces Institute of Pathology and his team said in the journal Nature that the 1918 pandemic began when the virus leapt from birds to humans, a scenario that mirrors what is happening in Asia today.

In a bid to contain the current epidemic, officials in Southeast Asia have slaughtered 140 million birds. That has not stopped the virus from spreading.

Bush met last week with the chief executives of four vaccine companies to determine how he can help them boost production enough to safeguard the population. The State Department on Friday convened a meeting of health officials from 80 countries to map out plans to arrest the flu's spread.

The administration's plan

The administration is putting the finishing touches on its long-awaited pandemic plan to be released after Leavitt returns from his trip. A draft version, dated Sept. 30 and leaked to The New York Times, reportedly predicts a major outbreak might kill up to 1.9 million people and make half the country sick.

Sen. Tom Harkin, D-Iowa, says he learned of the administration's prediction on Sept. 28 in a top-secret meeting in a secure room in the Capitol. He and a few other senators met with Leavitt; Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases; and Julie Gerberding, director of the Centers for Disease Control and Prevention (CDC).

The administration, Harkin says, predicts U.S. deaths from pandemic flu could range from 100,000 to 2 million, and as many as 10 million might be hospitalized. Up to 100 million might become sick. Seasonal flu epidemics kill about 36,000 people each year in the USA.

The briefing prompted Harkin to push for $4 billion in supplemental funds. "We saw what happened when you're not prepared," he says. The money will bolster surveillance, increase stockpiles of anti-virals, increase the vaccine supply, and help state and local health officials prepare for epidemics.

Fauci says the scary statistics resonate at the White House: "The president has taken a strong personal interest in getting this country prepared for pandemic flu."

Soon after he gets back from Asia on Oct. 18, Leavitt will unveil the administration's pandemic plan. He offered few details, but he sketched out the administration's aims:

•Improving the global network to detect disease outbreaks. The United States is working with China, India, Indonesia, Malaysia and others to strengthen surveillance.

•Heightening vigilance at home. Among other things, CDC is sending avian flu test kits to a network of labs.

•Stockpiling anti-viral medications. Leavitt has entered into negotiations with companies that make anti-virals, seeking enough to treat 20 million people.

•Increasing vaccine capacity. The United States wants to rebuild the vaccine market to give drug makers appropriate incentives to end shortages.

"A major part of our domestic plan needs to be domestic capacity, because in a pandemic, the emergency will be managed across the globe," Leavitt says. "Anyone with a supply produced in their country will want to keep it there."

Vaccines are less profitable than drugs, and drug makers worry about liability issues, such as those that arose when swine flu vaccine, produced in 1976 to avert an epidemic that never materialized, caused a nerve disease. The administration seeks to solve both problems by providing vaccine makers with a stable market and protection against lawsuits.

Hearne says health officials hope the administration's plan will be enough to deal with a flu pandemic. "The reality is that if a pandemic hits, it's not just a health emergency," she says. "It's the big one. It requires big thinking to make sure all those dots are connected. Katrina was a wake-up call."



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