Given the current scenario of birds spreading flu all over the world and H5N1 becoming endemic (semi-permanently established) in places like
Indonesia and
China, a brief summary and a reminder about history seem to be relevant.
While the US continues to struggle to prepare for a possible pandemic, and Europe deals with the discovery of the virus in a domestic cat in Germany, many questions have been raised about the relationship between the current H5N1 virus and the 1918 pandemic (caused by a novel H1N1 virus with unique characteristics of its own).
Interestingly, the History Channel will have a special on 1918 tomorrow at 8:30 am. And note also that one of the best summaries of the 1918 pandemic has been published by Jeffrey Taubenberger, one of the scientists who reconstructed the genome of the 1918 virus.
I want to highlight one brief section of Taubenberger's article, as it often comes up for discussion.
Even with modern antiviral and antibacterial drugs, vaccines, and prevention knowledge, the return of a pandemic virus equivalent in pathogenicity to the virus of 1918 would likely kill >100 million people worldwide. A pandemic virus with the (alleged) pathogenic potential of some recent H5N1 outbreaks could cause substantially more deaths.
Taubenberger is not an alarmist, or a "scaremongerer" (
whatever the hell that term is supposed to mean). He's a sober scientist, who respects this virus without committing himself or assuming that H5N1 is the next Big One. But he recognizes, as many of us do, that a pandemic, even a mild one such as in 1968, has the
potential to overwhelm our medical system. We have no surge capacity, or the ability to handle excess waves of patients, and our just-in-time delivery system of goods is
subject to failure. Economic concerns are reflected in studies done by
multiple sources, such as the
Lowy Institute and the Davos
World Economic Forum.
Another barely highlighted scenario is that 40% of thw workforce may not show in a pandemic for various reasons (including family illness and fear). In fact, this applies to health care workers as much as anyone else. Ontario is struggling with the concept as we speak:
Ontario's new emergency legislation isn't meant to force doctors and other health workers to stay on the job in an influenza pandemic, a government staffer said yesterday.
"Absolutely not," said Andrew Hilton, speaking for Community Safety and Correctional Services Minister Monte Kwinter.
Bill 56, tabled by Kwinter in December, gives the Ontario cabinet sweeping new powers to handle an emergency, including a disease outbreak.
The law, which the Liberals hope to pass before summer, has raised alarm bells because it includes a section allowing cabinet to "authorize" any person to render services during an emergency.
and given their SARS experience, when Ontario acts, the world notices.
Given what happened in 1918, and what's happening now, how should adults handle the situation without panicking? First of all, educate yourself about what's going on. Realize that H5N1 (bird flu) is a huge problem even if it stays in birds. It's causing billions of dollars of damage to the international poultry business as you read this. And experts are still uncertain about how it spreads (both bird migrations and commerce are likely responsible).
Keep a special eye on Indonesia, where the virus continues to cause infection and death in humans. And understand that the Feds say in case of pandemic, you're on your own.
Watch the 1918 special on the History Channel, or read john Barry's The Great Influenza and at least understand what drives the profound respect we have for this pandemic potential. There's always more at Flu Wiki, if your'e interested. And even if you're not, you're going to hear more and more about this, so get used to the concept. No one's trying to scare you, but getting ejumicated is a real good idea.
