Bird flu catastrophe may start hand to mouth

Bird flu catastrophe may start hand to mouth

Maggie Fox, Reuters/Washington

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.

Neighbors 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 neighbor, 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 neighbor 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 traveler 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 [ROG.VX] and Gilead Sciences'
[GILD.O] 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
Sept. 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.