I got this in my mail a few days ago:
Special Report: The Bird Flu and You
By Strategic Forecasting, Inc.
Stratfor subscribers have been sending us a steady river of
requests for our opinion on
the bird flu situation. Although we are not medical experts,
among our sources are
those who are. And here is what we have been able to conclude
based on their input
and our broader analysis of the bird flu threat:
Calm down.
Now let us qualify that: Since December 2003, the H5N1 bird flu
virus -- which has
caused all the ruckus -- has been responsible for the
documented infection of 121
people, 91 one of whom caught the virus in Vietnam. In all
cases where information on
the chain of infection has been confirmed, the virus was
transmitted either by
repeated close contact with fowl or via the ingestion of
insufficiently cooked chicken
products. In not a single case has human-to-human
communicability been confirmed.
So long as that remains the case, there is no bird flu threat
to the human population of
places such as Vietnam at large, much less the United States.
The Politics of Genetics
An uncomfortable but undeniable fact is that there are a great
many people and
institutions in this world that have a vested interest in
feeding the bird flu scare. Much
like the "Y2K" bug that commanded public attention in 1999,
bird flu is all you hear
about. Comparisons to the 1918 Spanish influenza have produced
death toll projections
in excess of 360 million, evoking images of chaos in the
streets.
One does not qualify for funding -- whether for academic
research, medical
development or contingency studies -- by postulating about
best-case scenarios. The
strategy is to show up front how bad things could get, and to
scare your targeted
benefactors into having you study the problem and manufacture
solutions.
This hardly means that these people are evil, greedy or
irresponsible (although, in the
case of Y2K or when a health threat shuts down agricultural
trade for years, one really
tends to wonder). It simply means that fear is an effective way
to spark interest and
action.
Current medical technology lacks the ability to cure -- or even
reliably vaccinate
against -- highly mutable viral infections; the best available
medicines can only treat
symptoms -- like Roche's Tamiflu, which is becoming as scarce
as the oftentimes
legendary red mercury -- or slow a virus' reproduction rate. Is
more research needed?
Certainly. But are we on the brink of a cataclysmic outbreak?
Certainly not.
A bird flu pandemic among the human population is broadly in
the same category as a
meteor strike. Of course it will happen sooner or later -- and
when it does, watch out!
But there is no -- absolutely no -- particular reason to fear a
global flu pandemic this
flu season.
This does not mean the laws of nature have changed since 1918;
it simply means there
is no way to predict when an animal virus will break into the
human population in any
particular year -- or even if it will at all. Yes, H5N1 does
show a propensity to mutate;
and, yes, sooner or later another domesticated animal disease
will cross over into the
human population (most common human diseases have such
origins). But there is no
scientifically plausible reason to expect such a crossover to
be imminent.
But if you are trying to find something to worry about, you
should at least worry about
the right thing.
A virus can mutate in any host, and pound for pound, the
mutations that are of most
interest to humanity are obviously those that occur within a
human host. That means
that each person who catches H5N1 due to a close encounter of
the bird kind in effect
becomes a sort of laboratory that could foster a mutation and
that could have
characteristics that would allow H5N1 to be communicable to
other humans. Without
such a specific mutation, bird flu is a problem for turkeys,
but not for the non-turkey
farmers among us.
But we are talking about a grand total of 115 people catching
the bug over the course
of the past three years. That does not exactly produce great
odds for a virus -- no
matter how genetically mutable -- to evolve successfully into a
human-communicable
strain. And bear in mind that the first-ever human case of H5N1
was not in 2003 but in
1997. There is not anything fundamentally new in this year's
bird flu scare.
A more likely vector, therefore, would be for H5N1 to leap into
a species of animal that
bears similarities to human immunology yet lives in quarters
close enough to encourage
viral spread -- and lacks the capacity to complete detailed
questionnaires about family
health history.
The most likely candidate is the pig. On many farms, birds and
pigs regularly
intermingle, allowing for cross-infection, and similar
pig-human biology means that pigs
serving in the role as mutation incubator are statistically
more likely than the odd
Vietnamese raw-chicken eater to generate a pandemic virus.
And once the virus mutates into a form that is pig-pig
transferable, a human pandemic
is only one short mutation away. Put another way, a bird flu
pandemic among birds is
manageable. A bird flu pandemic among pigs is not, and is
nearly guaranteed to
become a human pandemic.
Pandemics: Past and Future
What precisely is a pandemic? The short version is that it is
an epidemic that is
everywhere. Epidemics affect large numbers of people in a
relatively contained region.
Pandemics are in effect the same, but without the geographic
limitations. In 1854 a
cholera epidemic struck London. The European settling of the
Americas brought disease
pandemics to the Native Americans that nearly eliminated them
as an ethnic
classification.
In 1918 the influenza outbreak spread in two waves. The first
hit in March, and was
only marginally more dangerous than the flu outbreaks of the
previous six years. But in
the trenches of war-torn France, the virus mutated into a new,
more virulent strain
that swept back across the world, ultimately killing anywhere
from 20 million to 100
million people. Some one in four Americans became infected --
nearly all in one horrid
month in October, and some 550,000 -- about 0.5 percent of the
total population --
succumbed. Playing that figure forward to today's population,
theoretically 1.6 million
Americans would die. Suddenly the fear makes a bit more sense,
right?
Wrong.
There are four major differences between the 1918 scenario and
any new flu pandemic
development:
First -- and this one could actually make the death toll
higher -- is the virus
itself.
No one knows how lethal H5N1 (or any animal pathogen) would be
if it adapted to
human hosts. Not knowing that makes it impossible to reliably
predict the
as-yet-unmutated virus' mortality rate.
At this point, the mortality rate among infected humans is
running right at about 50
percent, but that hardly means that is what it would look like
if the virus became
human-to-human communicable. Remember, the virus needs to
mutate before it is a
threat to humanity -- there is no reason to expect it to mutate
just once. Also, in
general, the more communicable a disease becomes the lower its
mortality rate tends
to be. A virus -- like all life forms -- has a vested interest
in not wiping out its host
population.
One of the features that made the 1918 panic so unnerving is
the "W" nature of the
mortality curve. For reasons unknown, the virus proved more
effective than most at
killing people in the prime of their lives -- those in the 15-
to 44-year-old age brackets.
While there is no reason to expect the next pandemic virus to
not have such a feature,
similarly there is no reason to expect the next pandemic virus
to share that feature.
Second, 1918 was not exactly a "typical" year.
World War I, while coming to a close, was still raging. The war
was unique in that it
was fought largely in trenches, among the least sanitary of
human habitats. Soldiers
not only faced degrading health from their "quarters" in
wartime, but even when they
were not fighting at the front they were living in barracks.
Such conditions ensured
that they were: a) not in the best of health, and b) constantly
exposed to whatever
airborne diseases afflicted the rest of their unit.
As such, the military circumstances and style of the war
ensured that soldiers were
not only extraordinarily susceptible to catching the flu, but
also extraordinarily
susceptible to dying of it. Over half of U.S. war dead in World
War I -- some 65,000
men -- were the result not of combat but of the flu pandemic.
And it should be no surprise that in 1918, circulation of
military personnel was the
leading vector for infecting civilian populations the world
over. Nevertheless, while the
United States is obviously involved in a war in 2005, it is not
involved in anything close
to trench warfare, and the total percentage of the U.S.
population involved in Iraq and
Afghanistan -- 0.005 percent -- is middling compared to the 2.0
percent involvement in
World War I.
Third, health and nutrition levels have radically changed
in the past 87 years.
Though fears of obesity and insufficient school lunch
nutrition are all the rage in
the media, no one would seriously postulate that overall
American health today
is in worse shape than it was in 1918. The healthier a
person is going into a
sickness, the better his or her chances are of emerging
from it. Sometimes it
really is just that simple.
Indeed, a huge consideration in any modern-day pandemic is
availability of and access
to medical care. Poorer people tend to live in closer quarters
and are more likely to
have occupations (military, services, construction, etc.) in
which they regularly
encounter large numbers of people. According to a 1931 study of
the 1918 flu
pandemic by the U.S. Public Health Service, the poor were about
20 percent to 30
percent more likely to contract the flu, and overall mortality
rates of the "well-to-do"
were less than half that of the "poor" and "very poor."
But the fourth factor, which will pull some of the
strength out of any new
pandemic, is even more basic than starting health:
antibiotics. The 1918
pandemic virus was similar to the more standard influenza
virus in that the
majority of those who perished died not from the primary
attack of the flu but
from secondary infections -- typically bacteria or fungal
-- that triggered
pneumonia. While antibiotics are hardly a silver bullet
and they are useless
against viruses, they raise the simple possibility of
treatment for bacterial or
fungal illnesses. Penicillin -- the first commercialized
antibiotic -- was not
discovered until 1929, 11 years too late to help when
panic gripped the world in
1918.
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