Bird Flu Catastrophe May Start Hand to Mouth

10-19-2005

By Maggie Fox, Health and Science Correspondent

WASHINGTON (Reuters) - The scenarios all start out the same way -- at a
small farm somewhere, perhaps in Southeast Asia, some chickens become
infected with H5N1 bird flu.

They end with a global pandemic in which millions of people die, a
catastrophe beyond all living human experience.

The especially virulent H5N1 strain of avian influenza has been found
in flocks from Japan to Indonesia, and has moved west into Turkey and
Romania, and this week possibly Greece, where test results are pending.

The virus has infected 117 people in four countries, killing 60, and is
steadily mutating. Experts say it is only a matter of time before H5N1
bird flu changes enough to make it a disease that transmits easily from
human to human.

These changes may also make it less virulent -- but they may also make
it more dangerous. No one knows.

In a few potential scenarios, the world gets lucky and officials act
quickly to vaccinate populations and distribute lifesaving antiviral drugs. The
damage, while enormous, is limited and economies recover after a few
months.

But health experts are unusually united in warning that if H5N1 makes
the jump from birds to people in the next two years, it will cause an
unprecedented disaster.

"I want to emphasize the certainty that a pandemic will occur," Dr.
Gregory Poland of the Mayo Clinic Medical School in Rochester, Minnesota, who
represents the Infectious Diseases Society of America, told a briefing
last week of Congressional staffers and lobbyists.

"When this happens, time will be described, for those left living, as
before and after the pandemic."

STARTING WITH A SICK CHILD

So how will it start? Perhaps a child whose job it is to care for the
chickens will become ill with H5N1. Her desperate mother will tend to
her day and night. Inside the child's body the virus will mutate, just a
little bit.

She will cough as the virus affects her lungs, causing pneumonia. Her
mother will wipe the brow of the feverish, sweating child and unthinkingly
bite her hand to hold back the sobs of despair.

Neighbours hug and comfort the mother at the funeral. A week after the
child's death, the mother will become ill. News spreads through the
village. A nervous neighbour, fearful for her own children, takes them to
relatives who live far away.

Influenza spreads before people show any signs of illness. Within days,
H5N1 could be carried across an entire country before health officials could
be notified.

The neighbour could infect her relatives, one of whom has a business
trip to a major regional capital. The virus could easily infect a passport
agent, a doorman handed a tip, a baggage handler.

Like any other influenza virus, H5N1 is most likely to spread hand to
mouth -- and human beings are constantly touching their mouths, their noses,
and leaving small, wet, infected drops of saliva and mucus on everything
they touch.

Health officials in the province where the child has died suspect H5N1
but they are afraid of being quarantined, their economy stifled.

Probably all the flocks will be destroyed, and entire livelihoods with
them. The officials decide to err on the side of caution. Days pass while the
sick villagers are tested, and the unsuspecting flu-infected traveller has
passed the virus to dozens of people before becoming ill himself.

WAITING FOR TEST RESULTS

Tests for H5N1 require days to run. By the time it is clear what has
happened, two weeks have gone by and the new H5N1 mutant has been
carried by jet to eight cities around the world.

There is no controlling it.

The World Health Organization estimates range from 2 million to 150
million deaths, depending on how virulent the mutated virus turns out to be.
These will occur within months. AIDS has killed 34 million people, but has
taken 20 years to do it.

The 1918-1919 influenza pandemic killed between 20 and 100 million
people in 18 months.

"Even if you take every year the problems of malaria, tuberculosis and
HIV/AIDS, which are horrible, pandemic influenza has the potential in
just one fell swoop to kill so many more people than those diseases kill in
decades," said Dr. Mike Osterholm, a University of Minnesota infectious
disease expert who has been issuing some of the most dire warnings.

"Twenty-five percent of the population could get sick at the same
time," said Penny Hitchcock, an infectious disease specialist at the
University of Pittsburgh's Center for Biosecurity.

Hospitals around the world will be overwhelmed, and may themselves
serve to spread the infection. There will not be enough ventilators to keep the
very sick alive and breathing. Most people will elect to stay at home, dying
quietly in bed or, if they are lucky, surviving and becoming immune to
the virus.

"How do we handle the dead bodies?" Osterholm asked.

IDLED FACTORIES

Shipments of raw supplies will stop as countries close their borders.
Entire industries could grind to a halt -- including medical suppliers.

"You have two companies that make 90 percent of N-95 masks," said
Osterholm. These are masks that can filter out particles likely to carry viruses,
and that are the gold standard for protecting health care workers.

"How will healthcare workers come to work?"

Schools will close, and parents will be unable and unwilling to leave
their children to come to work. Many of these parents will be essential
workers -- nurses, firefighters, bus drivers, power plant employees -- who cannot
telecommute.

Antiviral drugs such as Roche's and Gilead Sciences' Tamiflu can be
used to treat patients and perhaps to prevent infection among family members of
known cases, but they are in extremely short supply.

"If it happened today, we have no Tamiflu and we have no vaccine," said
Dr. Isaac Weisfuse of the New York City Department of Health -- which is
more organized than many cities after the September 11, 2001 attacks.

An H5N1 vaccine will take six months to make, during which time
hundreds of millions of people could become infected.

Dr. Poland said the United States would need 600 million doses of an
H5N1 vaccine, because two doses will probably be needed for full protection.

The most flu vaccine the United States has ever been able to pull
together was 95 million doses in 2002. The factories that can make the vaccine
do not exist and would take years to build even if efforts started tomorrow.