OK

Here's this month's editorial in the prestigious international science journal Nature:

That the H5N1 strain of bird flu has not yet caused a pandemic is no cause for complacency. Preparations for the inevitable must be redoubled to mitigate the potential devastation.

Five years after the deadly H5N1 avian influenza virus exploded into a global epidemic in birds, it has infected more than 300 people. Happily, it has not yet evolved into a strain that can transmit easily between humans — an event that would trigger a pandemic that could kill tens of millions. But as long as H5N1 continues to be present in animals, that risk persists. And with so many other flu strains out in the world, all constantly evolving, a flu pandemic is inevitable.

The title of the editorial (The long war against flu) seems apt. H5N1 emerged as a major problem for humans in 1997 (Hong Kong) and again in 2003, and since then has been closely followed by the World health Organization, CDC and others (a text timeline through 2005 can be found here). We started writing about flu pandemics here at Daily Kos in 2004, asking the question "Pandemic - what's that mean? And what's that got to do with politics?" (and the answer is still "plenty." See Barack Obama's NY Times op-ed in 2005.) These diaries (Flu Basics: Science And Threats and Flu Basics II: Politics and Players written in May, 2006 are still, alas, relevant. More on Obama from the American Academy for the Advancement of Science 2008 election page (McCain's page is here, with no pandemic mention):

Senator Obama has said that preventing an avian flu pandemic is one of his national security priorities. He refers to his work with other Senators to provide $4 billion to the Centers for Disease Control to combat avian flu and to build a stockpile of antiviral drugs that had been in short supply.

See also question 6 of 14 Science Questions the Next President Should Answer:

Pandemics and Biosecurity. Some estimates suggest that if H5N1 Avian Flu becomes a pandemic it could kill more than 300 million people. In an era of constant and rapid international travel, what steps should the United States take to protect our population from global pandemics or deliberate biological attacks?

So taking stock years after the President's National Response Plan was published (November, 2005), after the cable media hype died down and after billions of federal, state and local dollars and man-hours (and quite a few diaries here at Daily Kos), it's worth a re-assessment of where we are at (for comparison, see 2005's Council on Foreign Relations: Pandemic Flu And Where We Stand.)

Declan Butler, Nature's senior science reporter has a terrific Q&A this week on the H5N1 topic, entitled whatever happened to bird flu?. Bottom line: we can't get rid of it in poultry in Southeast Asia (and Egypt and other places in Africa) so it sits there smoldering, waiting to infect humans, and waiting to potentially mutate to make it easier to catch. H5N1 remains a risk to humans.

And are we prepared? Not so much.

Like hurricanes, pandemics can't be predicted. We don't know when the next category 5 storm will hit and where, but the inevitability of severe weather is matched by the inevitability of flu pandemics. As we all now know, there were three in the last century (1918, 1957 and 1968) and the 1918 pandemic was truly devastating. Note the spike in mortality representing the 1918 pandemic.

Thjis is what would happen if the same severity pandemic happened today (modern medicine and all - click for bigger pic):


For that reason (mortality, and especially child mortality), the mitigating efforts of public health and national security agencies have taken place.

There are lots of holes in where we are. Not enough personal preparations have taken place (at least2 weeks of food and a water supply for every American are advised), and not enough information has reached the public (it's there if you go and get it.)

Our vulnerabilities are not so obvious, but our inter-related world and Just-in-Time economy contribute to our lack of resilience. For example, last week, I wrote about the price of oil and natural gas contributing to the price of latex exam gloves as an example of the nail-shoe-horse-kingdom chain of events that impacts on the cost of health care (and why it is not easy to rein in - see Health Reform: An Integrated Problem In An Integrated World), but the critical supply chain for food and goods is just as relevant for pandemic discusssions, as is our fragile electrical grid. The following pics come from Michael Osterholm at CIDRAP, U of Minnesota, and outlines the regional dependence of electricity on coal.

Our coal inventories are dangerously low (in terms of potential interruptions) Imagine if the folks who run the coal trains (and the mines) become ill.

This is why posts like 2007's Flu Stories: Is the Internet At Risk In A Pandemic? are relevant. So are energy stories, particularly when placed against the backdrop of worldwide food price hikes and potential and actual food shortages.

In the end, the risk of H5N1 (or some other flu virus such as an H7 or H9 strain) mutating and becoming a pandemic virus remains. Inevitably, a pandemic will happen (H5N1 being on the more severe end of possibilities.) What we can do is prepare ourselves for the inevitable, and in the process take a long and hard look at what we are doing on the energy front as well as the effects a natural disaster would have on surge capacity (see 2008's Pandemic Challenges For Hospitals.)

Whether it's rebuilding public health infrastructure, or including public health in health reform, or understanding the integrated just-in-time way of life we lead and protecting that as well, preparing for a pandemic will help us cope with whatever comes next. It'd be nice to know just what that 'whatever' is, but we're not always that lucky. Ask the folks in New Orleans whether more preparation time should have been spent, and whether we are spending enough time worrying about natural disasters now.

Originally posted to Daily Kos on Sun Jul 13, 2008 at 07:46 AM PDT.

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