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Published: Fall, 2005; Vol 7, Num 3

 

Talk of Deadly Epidemic
Underscores Flu Season Preparation

In the fall, as the flu season fast approaches, influenza is always a topic of health care conversation, but this year’s discussion has a new edginess.

Alternate description

LIUNA General Secretary-Treasurer and LHSFNA Labor Co-Chairman
Armand E. Sabitoni

“In the coming year, we are going to learn a lot more about deadly flu pandemics and how they can be managed,” says LIUNA General Secretary Treasurer and LHSFNA Labor Co-Chairman Armand E. Sabitoni. “To avoid panic and to take proper precautions that will minimize loss, we should all educate ourselves so we can be informed, responsible citizens in the event that a crisis occurs.”

The sudden upturn in urgency results from a scientific breakthrough announced in October. A team of researchers discovered that the virus that caused the 1918 global flu epidemic – a pandemic that killed 50 million people – was a mutant bird flu virus that jumped from birds to humans. That news sent shivers up the spines of epidemiologists worldwide because, since 1997, bird flu outbreaks have been on the upswing.

Poultry in more than a dozen countries has been ravaged, and more than 100 people – including 62 who have died – have contracted the disease. So far, nearly all the infected people got the virus directly from birds, indicating that the virus, though deadly to humans, is not readily transmitted from person to person.

The danger, however, is that it could further mutate in some way that makes transmission among humans easy. The science of virology is still rudimentary, but scientists believe further mutations in as few as 25 of the 4,400 amino acids in the H5N1 virus could turn it into a lethal, human-to-human killer.

General Principles
Of Infectious Disease Control

  • Have any symptoms of respiratory or diarrheal illness evaluated by a physician.
  • Practice proper infection control to avoid exposing others.
  • Cover your mouth when you cough or sneeze.
  • Wash your hands frequently and properly.
  • Use proper methods of food handling.
  • Maintain cleanliness of kitchen and bathroom surfaces.

If you doctor determines that you have an infectious illness and recommends that you stay home, do so. Don’t share infections with your co-workers.

As of now, there are no clear means to prevent or cure bird flu, whether in birds or in humans. Responding to the danger, the White House convened an October meeting of the nation’s top vaccine manufacturers to spur efforts to find a vaccine. Though no such vaccine now exists, one antiviral medication – oseltamivir phosphate (manufactured by Roche and marketed under the name Tamiflu) – is commonly used to treat influenza, including that caused by H5N1. If taken within 48 hours of infection, it prevents flu strains from replicating, but works only as long as the patient continues to take the pills. A successful treatment requires five or more days and costs $130. Unfortunately, signs of bird flu resistance to the treatment are already evident in Viet Nam and Japan, and researchers suggest the dosage (and cost) may have to be doubled.

The Bush administration has long been working on a plan to respond to a possible pandemic, which Health and Human Services Secretary Michael O. Leavitt said “will very likely occur in the future.” Early in November, the government issued its strategic plan, National Strategy for Pandemic Influenza [http://www.whitehouse.gov/homeland/pandemic-influenza.html]. Upon outbreak of an epidemic in Asia, the plan calls for efforts to prevent its introduction to the U.S. but concedes that, most likely, these measures would only delay, not prevent, its spread. Under the worst-case scenario, the plan predicts 1.9 million Americans would die, 8.5 million would be quarantined or hospitalized and the cost would exceed $450 billion.

Though general in nature, the plan calls for the strengthening of nation’s culture and services in regard to public health. In recent decades, spending at all levels of government on public health has declined relative to other priorities and the overall growth in the population. Though the President said he would ask Congress for $7.1 billion in new spending to prepare for a pandemic, as much as 75 percent of the cost of medications is left for states and local governments. More discussion of budget issues is likely.

The plan calls for a stepped-up national capacity to develop and produce both vaccines and antiviral drugs. It also takes a stand on which segments of the population should get priority for medication distribution. The top priority is the 40,000 workers in vaccine and antiviral-drug plants, followed by the nation’s nine million medical personnel.

Meanwhile, in a closed-door briefing of Senators early in October, Leavitt said the administration is preparing to order more Tamiflu, enough to treat 12 to 13 million individuals. However, as the administration developed its plan, other nations placed orders, and it now appears that adequate additional supplies cannot be acquired until 2007. Also, as worries of a possible pandemic mounted last month, many individuals attempted to purchase and hoard Tamiflu, an effort that caused the manufacturers and government to tighten distribution of existing supplies.

Though intensified research is unlikely to produce a reliable vaccine very quickly – certainly not in time for this year’s flu season (typically February and March, but no one expects a breakout of a humanly lethal bird flu this season) – scientists hope the genetic mapping of the 1918 virus will help focus this effort and speed a result.

1918 and Today

The fear of a pandemic was sharply boosted by the discovery in October that the 1918 epidemic originated as a bird flu.

Previously, no one knew what kind of virus the 1918 virus was or how it originated. That is because, in 1918, no one even knew what a virus was – the organisms were yet to be discovered. Later, after viruses were discovered, the “Spanish flu,” as it was known, had long since died out, and its virus was extinct.

Because the cause of the Spanish flu was unknown at that time, no one was able to keep a sample of the deadly virus. But, due to the marvels of modern medicine and the science of DNA, researchers were able to piece together the DNA of the original virus from fragments they retrieved from three people who had died in the 1918 epidemic. Lung tissue from two soldiers had been preserved at an Army pathology warehouse, and tissue was taken from an Alaskan woman who had been buried in permanently frozen ground.

Studies of the reconstructed DNA show that it originated as a bird flu, similar to H5N1, the avian virus that has plagued poultry in Asia since 1997 and recently appeared, for the first time, outside Asia in southeast Europe. Both the 1918 virus and the current bird virus are distinctly unlike the viruses that caused the two more recent flu epidemics among humans, those of 1957 and 1968.

By infecting mice and human lung tissue with the reconstructed virus, researchers have already uncovered why it is so deadly. It infects cells deep in the lungs and cells lining air sacs – cells that, typically, are impervious to the flu. Common human flu viruses do not kill mice, but the reconstructed Spanish flu virus and H5N1 do.

When he first assessed the rising threat of a pandemic, President Bush suggested the possibility of passing legislation to authorize the use of U.S. troops to enforce quarantines of regions of the country that might experience a deadly break-out. However, the strategic plan makes no mention of military deployment. Because the virus is carried and spread mostly by people who do not, themselves, become sick, public health officials sometimes impose a quarantine to confine healthy people to their home or to a city or other particular region. By limiting contact among people, a quarantine, theoretically, can keep a virus from spreading. Some medical historians credit quarantines imposed in 1918 with limiting the impact of the Spanish flu, but others question that assessment.

Whatever the case in 1918, it is less certain that a quarantine could work in today’s society. Not only is the population much larger, it is much more interdependent than in 1918, when the majority of Americans were family farmers. Broad quarantines would cause massive social and economic disruption. Further, the use of the military to confine apparently healthy people to particular places is likely to promote considerable social unrest. Most epidemiological professionals urge an open, trusting dialogue with citizens about the nature of the problem – a dialogue they hope will encourage voluntary cooperation with the action recommendations of the public health system.

“An informed public is our best defense against a new pandemic,” says Sabitoni. “There’s no need to panic, but we should not dismiss the seriousness of the danger we face. I urge you and your family to keep yourselves informed.”

Meanwhile, as discussion of worst case scenarios fills the news, preparation for the annual, winter round of the common flu proceeds. As in most years, a vaccine against this strain has been developed. However, for healthy individuals, this flu poses no serious danger; only the elderly, children and health care providers need to get vaccinations. If you’re part of one of these groups, contact your health care provider and get your shot as soon as possible, before the flu season arrives.

[Steve Clark]