H5N1 bird flu - The Global Crisis Advisory

The Pandemic spreads to Russia and is heading for Europe.
It is already in the U.S.?

The Global Crisis Advisory™

Copyright© 2005 by Geri Guidetti

Volume 1, Issue 1
August 1, 2005

The birds of Qinghai Lake in northwest China are taking flight.
Cold weather has arrived a bit early, so they are departing this normally
pristine breeding refuge for their winter feeding grounds in Australia, Europe,
Alaska and elsewhere. This year is different along these ancient flyways,
because the multiple bird species are carrying a deadly cargo that has left at
least 8000 of their brethren dead or dying on the lake’s shores. If they make
it to their destinations, a new, very dangerous strain of H5N1 bird flu
threatens the survival of birds, wild and domestic mammals, and humans on
several continents. This flight, now in progress, may mark the beginning of
the first Great Pandemic of the 21st Century.

Sometimes the truth is difficult to see and even more difficult to accept.
Consciously or subconsciously, we choose not to see, not to accept and then,
not to act. History will record that our collective failure to accept and act
on this developing crisis—in time—contributed to the massive human toll that
the pandemic took.

In fact, in the past few weeks, a growing handful of respected
scientists, physicians and public health officials around the world have
abandoned their usually calm, reassuring, public and private discourse and have
begun speaking, instead, of things like casket shortages, mass graves,
collapsing banks, decimated economies, scandalously unprepared medical systems,
and whole nations in denial. In meetings and conferences, on web logs and in
emails, they are pondering the need for refrigerated morgues; pushing their
governments to produce and purchase anti-viral medicines to treat one-third of
their country’s citizens; planning for agricultural disruptions and subsequent
food supply crises. They are contemplating the societal impact of forced
quarantines—inside homes with infected family members, and inside makeshift
hospitals in gymnasiums and schools. They see the healthcare
community—doctors, nurses, lab workers—as the first victims.

What do they see that their governments are only beginning to? The Avian
Influenza (AI) or bird flu epidemic that is spreading throughout Asia, is
looking and acting more and more like the long-expected, long-dreaded agent of
the next worldwide killer of tens- to hundreds of millions, or more, men, women
and children around the world. They see patterns in this evolving nightmare, and
in their governments’ responses to it, that are similar to those seen before and
during last century’s Great Pandemic, the Spanish Flu of 1918-1919.

There were three influenza pandemics in the 20th Century. Each was caused by
the emergence of a new subtype of influenza A. By far, the most deadly was the
so-called Spanish Flu pandemic of 1918-19 that killed more than half a million
people in the United States and up to 50 million worldwide, or about 3.5% of
the global population of 1.4 billion people at that time. If the coming
pandemic kills a “mere” 3.5% of today’s population of 6.5 billion, then 224
million people would die in 1-3 years. But if the current H5N1 strains are the
agent of this pandemic, it gets worse—much worse—than that. The death rate of
the bird flu spreading throughout at least 12 Asian countries ranges from about
20 to 72% in humans. Epidemiologists conservatively estimate that about
one-third or 33% of the Earth’s peoples will become infected if human to human
transmission becomes efficient. That is roughly 2.1 billion people infected.
If current death rates were sustained and materialized, between 420,000 million
to 1.5 billion men, women and children would die. In the United States, with a
current population of about 296 million people, 98.5 million may be infected
and 20-71 million could die! Contrast those numbers with the average flu
season’s 20-30,000 deaths, and you can see what is keeping these professionals
up at night.

Obviously, if anything near this fatality rate occurs, the outcome
would be catastrophic for the entire human race. Civilization as we know it
would simply cease to exist. Dr. Michael Osterholm is Director of the Center
for Infectious Disease Research and Policy, and Associate Director of the
Department of Homeland Security’s National Center for Food Protection and
Defense. He is respected worldwide in matters of emerging diseases,
bioterrorism and public policy surrounding these issues. In the July/August
issue of Foreign Affairs, a journal published by the Foreign Affairs Council,
Dr. Osterholm cites evidence and warns of the likely impacts of a pandemic that
might strike “tonight”, a year or ten years from now :

· Recent evidence suggests the current H5N1 strain would be similar to
the 1918 pandemic.

· More than half of those killed in 1918 were healthy 18 to 40 years old.

· Victims in 1918 succumbed to immune system responses called “cytokine
storms” that lead to acute respiratory distress. Victims of today’s H5N1 are
succumbing to cytokine storms, and we are still largely unprepared to treat it.

· A vaccine would not be available for months after a pandemic started
because manufacturers would have to know what strain to make a vaccine against.
Then it would take about 6 months to make if all went well. It would have
little impact on the pandemic during the first 12-18 months after it became
available.

· Antibiotics to treat the secondary bacterial infections that can occur
in viral pandemics will be “either unavailable or in short supply” for much of
the global population.

· “Virtually every piece of medical equipment and protective gear would
be in short supply within days of the recognition of a pandemic.” There are
only 105,000 mechanical ventilators in US hospitals. Every day, 75-80,000 are
in use. During a pandemic, the U.S. might need several hundred thousand
additional ventilators. Two countries in the U.S. provide most of the
protective masks for healthcare institutions around the world. Their components
come from components provided by multiple countries. “….masks may not even be
produced at all.” Will doctors and nurses continue working without such
protection? Gymnasiums and community centers would become hospitals that would
need staff for one to three years. They would likely die at the same rate
everyone else was dying.

· Supplies of antiviral drugs are very limited. Tamiflu takes up to a
year to produce and has been ordered by 14 countries, including the U.S.
Supplies of all anti-virals in the U.S. are limited due to manufacturing
problems. Who will have access to the very limited supply?

· Foreign trade would be reduced or end to prevent the virus from
entering other countries. “…the global economy would shut down.”

· Illegal border crossings would prevent successful containment.

· Up to 50% of the labor forces of affected countries might be ill.
There would be shortages of “food, soap, paper, light bulbs, gasoline, parts
for repairing military equipment and municipal water pumps...” Non-critical
industries such as electronics and automobiles might even close. School,
theaters, restaurants might be “banned.”

· How countries would “survive” 12-36 months of “extensive, long-term
outages” needs to be determined.

· “Global, regional and national economies would come to an abrupt
halt…the closest the world has come to this scenario in modern times was the
SARS crisis of 2003….Once SARS emerged in rural China, it spread to five
countries within 24 hours and to 30 countries on six continents within several
months.”

· Widespread infection and collapse of economies could lead to the
destabilization of governments.

· If we have a year before it hits, pandemic planning “must be on the
agenda of every school board, manufacturing plant, investment firm, mortuary,
state legislature, and food distributor in the United States and
beyond…Critical health-care and consumer products and commodities must be
stockpiled.” Vaccines could play a bigger role so efforts must be made to
increase the supply and ensure there are enough syringes to administer it.
Ethical issues such as how such a vaccine would be allocated around the world
need to be dealt with now.

· The public is often “indifferent” to disease warnings but fear often
hits after catastrophic infections hit, when it is too late for prevention and
control. Time is running out to prepare.

Unfortunately, many of the sporadic bird flu articles that are appearing in
newspapers, on television, radio and the Internet, are either riddled with
errors, inaccuracies and confusing misinformation, or they are so short and
incomplete as to render them nearly useless. They tell you we might have a
problem—sometime—but barely hint at how big, how wide, how deep, how horrific
the impacts could be. In a way, it is understandable, even forgivable, because
nobody likes to think the unthinkable. Most people have a hard time thinking
that anything like this could even happen today, in modern times, especially in
developed countries with advanced medical systems and brilliant scientists. The
Devil is in the details, as they say, and the details on this thing are
mind-boggling.

In fact, at this moment in time, the most imminent threat to human survival is
not war, not suicide bombers, not a nuclear attack, but this fistful of
frighteningly effective and adaptable viral agents, minute “genetic geniuses”
capable of morphing to evade immunity, break species barriers, and outsmart
man’s best efforts to control them. At this moment, they are multiplying in
animals and people in at least 12 Asian countries. No respecters of borders,
they have just invaded Russia and are nearing Europe. Within weeks, many
experts believe, they will be spreading to other countries and communities
along flyways taken by infected migrating birds, or in the lungs of a human
passenger on the next flight from China to Seattle to New York—with a stop-over
in Kansas.

Making matters more difficult, details of illnesses must now be leaked out of
China, as that country has chosen to make the truth about more recent
developments “a state secret”, according to a Chinese news service. China has
ignored the World Health Organization’s plea for more information about
reported illness and death in regions surrounding Qinghai Lake where a
dangerous new influenza A subtype has appeared. Ferreting out the truth about
the nature and extent of an epidemic with the potential to decimate human and
animal populations around the world is critical. It will take enormous
cooperation and coordinated global pressure and effort to prevent an all-out
human survival catastrophe of historically unprecedented proportion.

This is where we hope to play a role. With the Ark Institute’s and your
support, this Global Crisis Advisory™ has been launched to provide you, your
family, friends and our neighbors with reliable, timely information about this
developing crisis—and any others, natural or manmade—that threaten human
health, safety and survival. We will be speaking to scientists, medical and
public health professionals, as well as community leaders around the world, to
bring you the latest developments from affected communities, as well as
successful community protection programs that are really working.

But more importantly, every day we will consult experts who can help you decide
what to do to protect yourself and your loved ones. There will be information
on effective prevention techniques and treatments, including recommended doses
of anti-viral drugs that have proven effective. We will advise you of
voluntary and involuntary quarantines at airports, in hospitals and communities
in the U.S., information to help you make critical decisions about where to go
and how to get there. We will report, in every issue, on the scope and depth
of events occurring here and around the world.

Frankly, it is our hope that the Global Crisis Advisory is going to help save
lives—yours, your loved ones, and those of your neighbors. Make no mistake
about it: this thing is real, and it is coming. The only question scientists
can’t answer is “when?” And when it does happen, it will likely last,
epidemiologists say, for two to three years. Yes, you read that right…years.
Pandemics come in waves….but I’m getting ahead of myself. First, there are
other things we need to know to help us understand what will be happening.

Where Are We Today?

The Six Phases of a Pandemic
The World Health Organization (WHO) has outlined the following phases in the
development of a pandemic:

Interpandemic Period
Phase 1: No new influenza virus subtypes have been detected in humans. An
influenza virus subtype that has caused human infection may be present in
animals. If present in animals, the risk of human infection or disease is
considered to be low.

Phase 2: No new influenza virus subtypes have been detected in humans.
However, a circulating animal influenza virus subtype poses a substantial risk
of human disease.

Pandemic Alert Period
Phase 3: Human infection(s) with a new subtype, but no human-to-human spread,
or at most rare instances of spread to a close contact.

Phase 4: Small cluster(s) with limited human-to-human transmission but spread
is highly localized, suggesting that the virus is not well adapted to humans.

Phase 5: Larger cluster(s) but human-to-human spread still localized,
suggesting that the virus is becoming increasingly better adapted to humans,
but may not yet be fully transmissible (substantial pandemic risk).

Pandemic Period
Phase 6: Pandemic—increased and sustained transmission in general population.

The pandemic in birds is in Phase 6. Depending on the findings in
frightening new developments in China, we are either in Stage 4, 5 or even 6.
Here are the important facts:

What IS This Thing? A Primer

As events unfold, a simple understanding of some of the nomenclature
you will be hearing might help you to see the big picture. Influenza A viruses
such as this avian influenza, belong to a subfamily of viruses called
Orthomyxoviridae. They have variable shapes, but most are ovals or spheres a
mere 80-120 nanometers in diameter. A nanometer is one-one billionth of a
meter. You need an electron microscope to see them.

How they are constructed is the key to their success (or failure) at infecting
animals and/or humans. Their genetic material, at the core of the virus, is
divided into eight segments made of RNA (ribonucleic acid). Each segment has
a code for producing one of eight different proteins (polypeptides). Each of
these eight proteins has a role in infection and/or replication (billions of
copies) of the virus. Two of these proteins form spikes that stick out of the
fatty (lipid) envelope surrounding the virus’s core. One type of spike is
called Haemagglutinin or HA, and the other type of spike is called
Neuraminidase or NA. Scientists use even shorter nicknames for these proteins:
H and N. To make things even more interesting, there are 15 known H types
(serotypes) and 9 known N serotypes. Now I think you might be starting to see
the big picture: A virus can have an H spike that is either a 1,2,3,4…..or 15,
and it can have either a 1,2,3,4…..or 9 N spike. The nickname of the dangerous
form bird flu that you have been hearing about lately has a #5 H spike and a #1
N spike, or H5N1. These may change as time goes on, but for now, this is the
beast we are dealing with, though it is a bit more interesting. There are a
number of H5N1 serotypes with reassortments and recombinations of genes and
gene segments circulating throughout Asia. Some are more pathogen