Sometimes
getting media attention is more a curse than a blessing. There is a ton
of misinformation out there about the flu, and what to do about it, and
the media, by dealing with the issue piecemeal, is contributing to the
confusion, inappropriate reactions, and misdirected fear, rather than
helping the situation.
Lets start with what not to do about the flu:
- Don't panic about the unavailability of vaccine:
The vaccine out there is for established influenza viruses, not for
those that haven't (yet) evolved into pandemic strains. Get a flu shot
if you're at risk from these established strains, but otherwise don't
get stressed if there isn't enough.
- Don't assume the risk of pandemic is all media hype:
History is punctuated with flu epidemics, and there is no current or
foreseeable science that will prevent this from continuing. We're
overdue for a big one. The chances of a flu pandemic in any year varies
from about 3% to 10%. It's rare for any generation to completely escape
one. That hasn't changed -- recent science has not equipped us to
reduce the risk or severity of flu pandemics..
- Don't blame the birds:
The current poultry flu, the H5N1 strain, does not easily pass from
poultry to humans. It spreads from poultry flock to poultry flock, due
to (a) the increasingly few different breeds of poultry raised around
the world (b) the horrific concentration of farmed poultry, and (c) the
high volume of international trade in poultry. These dangerous farming
practices mean that poultry flu outbreaks are virtually inevitable and
spread like wildfire. As a result, the massive slaughter of poultry is
becoming almost routine. Quarantining poultry flocks is pretty futile
-- there are too many flocks and too much trade to hope that we can
hermetically seal off an infected flock from the rest of the world.
Although some migratory birds can carry the disease,there is no evidence
that non-poultry birds have played any significant role in the spread
of poultry flu around the world. The market has done this. And flu is a
very adaptable virus -- it can mutate to be able to jump from one
overcrowded species (poultry) to another (humans). But this happens
very rarely, so there is no reason to get paranoid about contact with
birds, or even, if that is your preference, from continuing to eat
poultry worry-free. And if a mutation of the poultry H5N1 jumps to
humans, then the problem has nothing to do anymore with chickens -- the
pandemic will spread simply and very quickly person to person. Or an
existing human flu variant may mutate to make it immune to our
vaccines, so the pandemic may well be entirely 'man-made'. And we can't
"cull" human herds to stop the spread, so it will likely spread faster
among humans than among poultry.
- Don't believe muddle-headed politicians
who say that the government is taking care of the problem and there is
nothing they as individuals need to do or worry about. Especially
presidents of countries who have already shown they are utterly
unprepared for and incapable of handling disasters.
OK, some basic facts about influenza:
- H5N1 is a scientific description of a strain of influenzas.This
strain is very virulent (high death rate), but currently does not
spread from human to human, or from other species to humans, as
effectively as other flu strains. But since viruses are so
opportunistic (mutate in multiple ways so that the more successful
mutations evolve to replace less successful ones), it's almost
inevitable that some mutation of H5N1 or of another influenza strain
will emerge that is more transmissable, and that's when the pandemic
will occur. That's will, not might.
- Tamiflu and Relenza anti-virals are not vaccines or super-vaccines.
If taken regularly they can stave off the effects of a variety of
viruses. But they are far from a panacea, and not nearly as effective
as a vaccine targeted to a specific flu variant. And the stockpiles
that would be needed to equip an entire population are astronomical, so
they will only be useful for front-line emergency workers and
already-infected patients, as a supplement to other procedures to try
to limit the spread of a pandemic. And there is evidence that the latest flu strains could be resistant to Tamiflu.
- The current 'business' of vaccine research and manufacture is archaic and risky. We are beginning to realize this, and improved methods, much more public
funding of research, manufacture and distribution of vaccines will
eventually improve this. But this will take decades. And there is no
way to know whether vaccine technology will ever be able to catch up to
the astonishing ability of viruses to mutate opportunistically. So
drugs (anti-virals + vaccines) are not the answer.
So what should we do?
- On a global, national and local basis, we need to develop contingency plans
for worst-case scenarios of flu pandemic -- coordinated plans for what
governments, authorities, companies and individuals will do when a
pandemic hits. We need to learn the lessons of Katrina and of history
-- especially the H1N1 1918 flu pandemic (which did not stem from birds).
Those contingency plans include preparing for provision of food, clean
water, medicines and heat and other essential supplies to people to
keep civil society operating when the economic infrastructure
temporarily collapses. They include providing a level of emergency
security that was so pathetically absent after Katrina -- and that
doesn't mean sending in untrained, unprepared, clueless military
recruits. They include designating delivery people as essential
(immunized) workers -- instead of us all going out for what we need, if
these immunized workers bring it to our homes, the risk of spread is
drastically reduced. They include identifying and mobilizing people who
are found to have a natural immunity to the influenza (even though we
won't know how many or who these will be in advance). And at every
level -- right down to the local school, hospital, municipal fire and
police and municipal planning department -- these contingencies plans
need to be put in place ready to launch on short notice. And it means
establishing a degree of coordination and open, honest communication
between governments that today is non-existent and which, for cultural
reasons, will not come easily,
- On a global level, we need to help third world countries be prepared to handle a pandemic as well as we do.
Pandemics respect no borders, and it is almost fruitless to prepare
some countries and not others. This is a lesson some "build a wall"
advocates seem incapable of learning. Would we be willing to give our
stockpiles of anti-virals to a poor nation infected with H5N1, to try
to ring in the infection there before it can spread to us? Don't bet on
it.
- We need to accept that a pandemic is very likely, sooner or later, and that its death toll is likely to be high (anywhere from 5 to 150 million is probably not a bad guess), and that the death toll will be mostly a
function of the virulence of the strain, not on anything we do to
prevent or try to stem its spread. So let's say what the politicians
won't: There will be another
flu pandemic, and millions are going to die. Our preparedness won't
significantly change that, but it will help us cope with the fallout
from that massive death toll, possibly preventing riots, civil strife,
wars, and collapse of our economic and health care systems. That alone
makes it worth being prepared, even if it doesn't save a single life.
- At a personal level: (This is what you were looking for, right?)
- We
need to ensure we follow and teach others basic hand-washing, cough-
and sneeze-covering (with tissues, by wearing a mask when sick, or if
necessary using our sleeve
rather than our hands) and other hygiene. This needs to be reinforced
with signage, and automated no-touch restroom hygiene in public places.
- We
need to think, at our workplaces, about how we will keep things running
when absenteeism suddenly soars to 20% -- or 70%.
- We need to think about switching work to home, and school attendance to home schooling or 'virtual' schooling.
- We
need to think about what we will do if we are infected but don't
contract the disease -- because that natural immunity makes us a very
valuable commodity, and perhaps imposes a personal responsibility on us
to get out and do volunteer work during the pandemic that we might
otherwise not do.
- We need to learn, and decide, what to do if a loved one becomes ill when we are not.
- We need to have a list of essentials to stockpile now, or at the very first sign of an outbreak.
- We
need to appreciate that if a pandemic occurs, it will become global
quickly, and if it hits us, for the most part we will be on our own. No
emergency help will rush in -- it will be far too late for that. Once
it starts, at best our area will be quarantined, at worst completely
ignored. And pandemics occur in waves before they subside, so surviving
a first infection may not be the end of it -- we need to be prepared
for the long haul.
- We need to become involved in bottom-up
community preparedness programs, ensuring that our local authorities
are as ready as we are.
Feel better now?
Thanks to all the writers of level-headed and useful material on this subject, such as WHO, HHS, various science journals and especially Peter Sandman's wonderful article on preparedness, for the information summarized above. |
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