worldwide mass death!! COMING SOON!!!!!! : a calm, measured, practical(-ish) guide to avian flu
Oct 11, 2005 Write an essay on this topic.
Popular Products in BooksThe Bottom Line I'm too informative for my love, love's going to leave me. I'm too informative for my shirt, so informative it hurts. I'm a Cassandra, you know what I mean.
(I have read various articles on avian (bird) flu, its potential to cause human disaster, and what we can do in response. That said, this article is largely my summary of the thoughts of one extraordinary thinker, professor Peter Sandman: employed in the Public Health and Ecology departments at Rutgers, in the Environmental and Community Medicine department at Johnson Medical School, and as a consultant in risk communications by various government agencies, activist groups, and corporations.
This isnt the kind of article I _expected_ to write on my birthday, and if you hadnt heard anything about the problem til just now, this article will be sorta alarming. But its not just alarming; I find it a happy fact that people like Sandman and his wife/partner Jody Lanard (with the World Health Organization) have such sensible things to say, and say them so well. I do not write this to say Be scared! I write it say Be scared! For a little bit! Then heres some stuff we can maybe do that might help. So that youll be alive and able to read my work when I write goofy stuff. The Yankees just lost, and we live in a beautiful world. See www.psandman.com for far more info.)
Q: What is the flu? I mean, regular, normal flu?
The flu is a disease that arrives every winter, always in slightly different form: its evolution at work, as each strain of flu is bred from the surviving viruses that werent killed by last years flu shots and antibodies. Still, the flu has always been of the type H1, H2, or H3 a reference to the proteins on the outer coat of the cell and so we come with some level of immunity to it. The flu infects tens of millions of Americans each year, but only kills 35,000 or so: about the same number of Americans that die each year from guns or car wrecks. The other 99.9% of us get the flu, sneeze, sniffle, barf, miss some days of work, and go on with things. The flu mostly only kills old people, babies, and anyone trying to sell cocaine in an area controlled by a flu-virus gang.
Q: Not that Im in favor of barfing, but how is this scary?
As I said, every flu is a little bit different from the one before. In 1918-19, the Spanish flu (which was probably not called that in Spain) killed more people than were killed in combat during all of World War I. That was extreme, but the flu seasons of 1957 and 1968 also killed unusual numbers of people. Its just random, as far as we know.
Q: What makes this avian flu so special?
So far? Its killing tens of millions of chickens, which sucks for the chickens; and its been transmitted to humans, mostly chicken farmers, in about two hundred known cases, 70% of which resulted in death. As long as this new strain is for the birds, humans are fine. (My apologies to any birds reading this.)
HOWEVER. Epidemiologists people who study the spread of disease for a living are very afraid that, at some point, a person with avian flu is gonna spend time in a hospital with a human who has human flu, and the viruses will meet and mate, trading DNA: hospitals are the singles-bars of the viral world. One very possible result is that the avian flu could acquire the ability to pass easily from person to person, just by coughing or sneezing or drooling. At that point, the flu would spread fast: it would sweep the world in weeks or months, again just like the usual flu.
When Peter Sandman wrote his most thorough article on the topic, in November 2004, epidemiologists were united in the belief that this event is very, very likely to happen in the next few years. Sandman wondered at the time whether there might be some element of groupthink, of a tight community of experts all feeding each others fears. Perhaps so: as of his newest article (posted yesterday), I get the idea that theres more of a 50/50 chance overall, no more than 10% likely in a given year, and a few experts no longer believe it will happen at all. Though again, of course, these are no more than highly-educated guesses.
But heres the thing: the avian flu is type H5. We dont have _any_ immunity to a type H5 flu. And as the American Indians learned in the 16th century (or would have if they'd taken lab courses at Johns Hopkins), exposure to a new type of disease can be a very bad thing. The consensus estimates that, if the H5 flu starts damaging humans, a quarter to a half of the worlds people will catch it. Somewhere between 7 million and 360 million people will die worldwide.
Q: AAAACK! Ohmigod ohmigod ohmigod!
There are 6.4 _billion_ people in the world. Even the most alarmed expert (Dr. Michael Osterholm of the University of Minnesota) does not expect you, personally, to die of the H5 flu though hed expect you to know someone who dies of it.
Q: Heh. I know a couple people Id nominate. I guess thats not so bad, then?
The problem is how a serious flu tends to spread. In any given community, it would likely come in waves, two or three waves over the course of maybe two years. (The first wave would probably be the least awful.) It would be a pandemic, based on pan as the Greek for all: we couldnt rush help to affected communities, Hurricane Katrina style, because communities everywhere would be affected, and there wouldnt be enough help to go around.
Most people wouldnt die of flu, but a huge minority of the population would be too sick to go to work, and not that many healthy people would be eager to go outside in order to _get_ to work. In the absence of any planning, that would mean: too few cops, too few firemen, too few teachers, too few delivery people, too few truckers, too few sewage workers, too few farmers and harvesters and packers, too few doctors and nurses even for normal times. Where would we get food? Heat? Clean water? Not dying of the flu itself is the easy part.
Q: Ive heard stuff about flu-vaccine supply. I guess we should really step up the amount of vaccine we have ready, huh?
Sure. But wed be fools to rely on that as our best solution.
First off, we dont _have_ a vaccine for H5 flu, although a couple of promising vaccines are in testing stages. Second, at current vaccine production rates, it would take 14 years to manufacture enough vaccine to protect the world even if we did have an H5 vaccine (which we dont). Third, just as the regular flu changes every year meaning that last years flu shot is only a little bit useful, at best so is the H5 flu likely to change every year: even if we find a vaccine that works now, it might be of little or no use if the flu makes the jump to human-to-human contagion in, say, the winter of 2007-08.
Its definitely worth stepping up our _ability_ to produce vaccine in a hurry, for when (if) the human H5 flu hits. Private pharmaceutical companies have no motive to do this: the investment would be expensive, the vaccines themselves would be expensive, theyd risk lawsuits if a vaccine didnt work, and they might get stuck with emergency price controls that would prevent them from charging enough money for their vaccine. Its a loser deal for a private company, all the way around. Only the government can step up vaccine-producing ability in a big way but it might save millions of lives (and hundreds of millions of sick days) in the process. Or not.
If I read Sandman correctly, he also thinks stockpiling a vaccine in advance, once we find one, is worth trying. But it would be expensive and might not work. If it did work, there would be nowhere near enough for everyone. Therefore, we should decide now who it would be most important to deliver a vaccine to, once one is found and in production. Traditionally, flu vaccines are focused on the most vulnerable: the elderly, the kids, the weak. Sandman believes we should plan to deliver vaccines first to the nurses, the firefighters, the electrical workers: the people we depend on to keep society going. I think we should first protect the skinniest and most long-winded among us. Regardless, its worth deciding in advance, and deciding together: after all, were also deciding whod be left to risk death.
Because one things almost certain: _if_ the H5 pandemic flu jumps into the human population and races around the world, we cant stop it. We cant even stop it from being, by far, the worst thing to hit human civilization since World War II. All we can do is control the damage, by preparing as smartly as possible.
Q: How do I prepare?
That depends who you are. Theres a few things any of us can think about: for example, if you had to work from home, could you do it? (If not, could you talk your employer into creating some work-at-home method?) Do you own a surgical mask? Is there any way you re-arrange your home to make it easier to care for a sick family member and not get infected by them? Could you help talk your employer in retro-fitting the doors so they can be opened with elbows instead of hands, and the sinks so they can be turned on and off with elbows? (It sounds funny to me too, but I guess it really helps fight the spread of germs.)
Also, as kindergarten-y as it sounds, do you always wash your hands when you go to the bathroom, and cover your mouth when you cough? You dont? Gross! Now might be a good time to start, just for the sake of practice.
Beyond that, the H5 flu pandemic will (if it happens) be a local issue. Because nowhere will be in a comfy place, ready to send out help; because travel will be cut way down, to slow the spread of disease, each business and agency and community needs to make plans of its own. Some, happily, are already starting: the recent appointment of David Nabarro as the first-ever United Nations Pandemic Co-ordinator has drawn a lot of attention to the issue. Many arent, of course. Some suggestions, in Sandmans own words:
-- Manufacturers and service providers can rethink their inventory control procedures. What will they be able to provide for themselves if their usual supplier can no longer make it or ship it? What can they do without in a pinch? What do they need to stockpile?
-- Every organization can rethink its staffing needs. How can we get essential tasks done despite soaring absenteeism? What sorts of cross-training now might save the day later?
-- Every organization can rethink its social contact needs. Disease transmission is a function of the number of social contacts keeping people home more means keeping more of them alive. What jobs can shift to telecommuting? How can we educate children without making them come to school? How can we distribute food without making people come to the supermarket or the soup kitchen? Should we redefine delivery person as an essential job that qualifies for antivirals?
-- Nonprofits can start planning to coordinate volunteers. Like any emergency, a pandemic will yield huge numbers of people who want to do something to help including many who contracted pandemic influenza and survived, and are therefore immune. Who is going to sort them out and get them where theyre needed most, doing high-risk jobs that dont require special skills (washing linens at the hospital, for example, or making deliveries to people sick at home)?
-- Local governments can ask themselves hard questions about leadership and survival. How will they keep essential services (police, fire, water and sewerage) operating? What inessential sources of infection (movie theaters and restaurants, for example) will they want to shut down? Where will they put the bodies when the morgues are full? How will they maintain order?
-- Above all, push every organization youre tied to your church, your employer, your club, your childrens school to start its own pandemic planning process.
Q: Okay, then. Happy birthday. But if no one thinks its more than a 10% chance to happen this year or 10% next year if, in fact, it might never happen what is the point of thinking about it now?
Because its always easy to put off planning until the last minute, and always easy to assume that will work out fine. It doesnt.
Back when half of New Orleans was swampland, experts warned that draining the swamps to make more city would make the people (and buildings) vulnerable to giant floods. The city drained the swamps. Back in 1996, the experts warned that the levees would never withstand a category 4 or 5 hurricane; their warnings were ignored. Until 2002, the Federal Emergency Management and Dog-Show Agency did stage frequent drills with local National Guard units for various emergencies, including floods, but then those drills were stopped. In 2004, Interim Executive Management, Inc. ran a simulation of Category 3, 4, and 5 hurricanes over New Orleans, showing all of them as fairly disastrous; IEM recommended a series of planning steps to prevent such a disaster in real life. FEMA placed half the report gently on a shelf in the nearest dungeon, next to the dragon chow, and used the other half as cute black-and-white wrapping paper. The steps were not implemented.
In 2005, a Category 5 hurricane hit New Orleans, and most of the city was pretty much wiped out. It wasnt certain to happen; it was just sorta likely. Maybe. Eventually. A little too soon. Oops.
My next piece will be either a review of some cute movie, or something completely pointless and silly. Here was just some stuff to think about, and maybe to ask your boss to think about (if s/he cares what you think). Im not in this writing gig to save lives, and I bet you aint in the reading gig for that either. Its not fun, and maybe there's no need to try. But just in case yknow?
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