Sunday, September 25, 2005

On the Emerging Avian Flu Problem

On September 22, Rick Moran, aka “Superhawk” — administrator of Rightwing Nuthouse — posted a fine and timely article on the emerging threat of Avian Flu, which seems to be cropping up in a number of Asian locations.

• The BBC’s online news reported in an article dated 15 August that the so-called “Bird Flu” had spread westward as far as the area of Chelyabinsk, where the Ural Mountains form one of the last geographic speed bumps to the spread of the disease from Asia into Europe. The disease primarily affects wild aquatic birds and domestic poultry, and the Chelyabinsk region is blessed with thousands of lakes that migratory aquatic birds in huge numbers visit in passing. The virus has already required massive culling of market-raised poultry in some areas, and may be expected to devastate the local farms there as it has in several other Asian regions.

At the time of that article, Russian sources indicated no human cases in Chelyabinsk, even though a virus strain found in humans in nearby rural areas was identified as the type that had caused human fatalities elsewhere.

• In Jakarta last week, health authorities have confirmed that several workers at the city’s Ragunan Zoo have been infected with the strain of Avian Flu identified as the “H5N1” virus, after the virus was isolated from 19 birds that are part of the permanent zoo population. (“H_N_” is a code for the protein sequencing that effectively distinguishes various viruses, and in turn suggests anti-viral strategies to the researchers.) The same report indicates a handful of infections in people not connected to the Zoo, of whom one 37-year-old woman died.

It may seem like a lot of fuss over a handful of humans infected out of a population of billions. We hear of avian flu year after year, and it’s had enormous economic consequences in some areas, causing the outright deaths and preemptive destruction of hundreds of millions of poultry in the last few years.

But this time, things could be very different.

There are several factors that make it so. One is the virulence of the virus, even just considered in its effect on the birds. In some outbreaks, the virus killed almost every single chicken infected. That level of lethality is bad enough for its economic impact, but it is particularly sobering if it conveys along with communicability among different species.

And in fact, the H5N1 strain of Avian flu has learned to jump from birds to humans, and though it has not yet spread widely, the record demands attention. Considering how outraged people were last fall over the anticipated shortages of vaccine, you’d think there might be a little more interest. After all, this particular version of the flu gives every indication that it poses a very real and potent threat, not just an inconvenience.

I know it’s difficult to sort out truly urgent data amid the regular spasms of hysteria that the alleged Mainstream News Organizations seem to increasingly depend upon for capturing the attention of readers. The vaccine shortfall worries that surfaced during the presidential election of 2004 have added to the long list of real concerns that are too complex for most people to examine rigorously even when politics are not pumping adrenalin into every conversation. Recall now that despite the hysteria the flu season wound down with a surplus of several million doses. I’m not saying the worries were unjustified, but that the questions were never discussed rationally, because the issue was hijacked by those who saw it as just another weapon to use to unseat a hated incumbent.

There certainly needs to be further public conversation on issues of public health policy. Yet we seem to be happier pissing away our energy in shouting matches than in daring to address the relentless spread of HIV, antibiotic-resistance in diseases once thought mastered, and the emergence of new pathogens.

Example: Tuberculosis has re-emerged most conspicuously among urban homeless drug-abusers in the last decade in virulent strains that defy all but the most exotic and expensive antibiotics. The ACLU, abandoning reason for political correctness, fights to shield those homeless drug-users from involuntary confinement or any other coercion by the government meant to ensure they take the medications correctly. So the resistant Tuberculosis spreads and grows more robust. At some point people need to wake up and grasp that a plague won’t spare anyone for their politics. Set aside the brickbats and work with people whose views you find obnoxious, to address and solve the acute problems that threaten all.

One writer who has done a tremendous job of framing the challenge of infectious diseases in the last decade is Laurie Garrett.

You might recall her as NPR's eloquent science reporter for a decade, wrote an excellent book a few years back, “The Coming Plague.” Reading even just a few chapters of that book will give you a pretty good sense of the real problems involved in identifying and preparing for new infectious diseases, and the political and social hurdles in implementing policies and medical programs.

More recently she has written an excellent comprehensive article for Foreign Affairs, the online e-magazine published by the Council on Foreign Relations.

It's lengthy — some 5,000 words, or about 13 pages — but you can't read it and walk away with any lingering doubt that it's worth preparing against the threat posed by Avian Flu and its sibling strains. In the first paragraph, she points out that Avian flu has killed about 50 percent of documented patients infected since 1997. A few paragraphs later she relates that examination of U.S. records from the “Spanish Influenza Pandemic” of 1917 to 1918 indicate a mortality rate of about ONE PERCENT of all persons infected.

Ironically, where we have become accustomed to warnings that young children and the elderly are thought to be most vulnerable to flu outbreaks of the last few decades, the Spanish flu was most savagely fatal among young adults, possibly because the older populace had gained partial immunity from several nationwide flu outbreaks some decades earlier.

To sum up, Avian flu is on its way. With a bunch of unpleasant relatives simmering in the background. We need to pay attention, and support the folks who actually get things done, instead of just posing and pontificating. In many ways, Jonathan Swift’s book “Gulliver’s Travels” pinpointed the absurdity of political wrangling in all societies at all times. We’re like a bunch of oysters clamoring for a ban on chowder recipes.


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