WHO -- just another fear-monger?

[Orstio]

http://www.iol.co.za/index.php?set_id=14&click_id=117&art_id=vn20041130051751967C809147

Hong Kong - Up to 100-million people could die in weeks if a bird flu pandemic broke out, a senior World Health Organisation (WHO) official has warned while urging countries to make urgent preparations to mitigate its spread.

There is this recent scare, and then there was the earlier scare on SARS, which now ranks #2 on the search for "who".

http://www.who.int/csr/sars/en/

Now, there are a lot of "fuzzy" numbers surrounding the SARS scare, including:  In Canada, the "SARS" outbreak was limited mainly to young children and the elderly -- much like influenza.  In contrast, SARS in China and other eastern nations was fatal mainly for people considered young and healthy.  It does not sound like the same disease.

Since its discovery in early 2003, there have been only 8096 deaths worldwide.  Worldwide deaths due to influenza (which we refer to so frivolously as "the flu"):

Although difficult to assess, these annual epidemics are thought to result in between three and five million cases of severe illness and between 250 000 and 500 000 deaths every year around the world.

From the WHO.

Why are we so concerned about SARS and chicken flu, again?  Oh yeah, the WHO keeps releasing absurd statistical predictions of outbreaks of these little known diseases, playing on people's fear of the unknown.

[Astronuc]

I agree that statements like "Up to 100-million people could die in weeks if a bird flu pandemic broke out" are unfortunate.  That certainly scares people.

I would think that it would be sufficient for health departments around the world to remind their respective populations that an occurrence of flu seems to be picking up that people should take extra precautions - such as washing hands - as well as getting immunity shots.

Then we just had the situation of millions of doses of flu vaccine being destroyed because of contamination (or potential contamination) at the supplier, and some people went nuts.  A few ederly people actually died from accidents like falls while waiting in line for 'flu' vaccines.  Some doctors were threatened when they withheld vaccinations from adults who children were being vaccinated.  The doctors were following guidelines to limit vaccinations to children 5 and under, and the elderly - due to local shortages of the vaccine.  Still, some people got flu shots on the 'black market'.

[Orstio]

Then we just had the situation of millions of doses of flu vaccine being destroyed because of contamination (or potential contamination) at the supplier, and some people went nuts.  A few ederly people actually died from accidents like falls while waiting in line for 'flu' vaccines.  Some doctors were threatened when they withheld vaccinations from adults who children were being vaccinated.  The doctors were following guidelines to limit vaccinations to children 5 and under, and the elderly - due to local shortages of the vaccine.  Still, some people got flu shots on the 'black market'.

This is where people's ignorance and fear starts becoming harmful to us all as a whole.

Flu vaccines are effective for those in high-risk demographics (young children and the elderly).  For the rest of the population, one's own immune system is a far better defense.

There are also cases of influenza A, which require further medical attention, and are often ignored until they become life-threatening, because of people who go to the doctor with trivial symptoms.  Doctors become jaded to people showing flu-like symptoms.

We certainly do not need an organization like the WHO causing even more fear and ignorance in the general public. 

I wonder how many people in the US believe that a flu vaccination would protect them from the chicken flu?

[Yevaud]

Sadly, Orstio, probably a large number.

My own experience in the field (Biomedical Engineering, 13 years professional experience) is that people usually feel that they know far more than they actually do.  A great example of this is several years ago, when I was taking the subway here in Boston home.  The Red Sox were playing that day, so the "T" was packed.

In front of me were two Tradesmen - Welders, or so I gathered.  One of them said, "my Doctor says I need an MRI."  And his friend says, "Naw, you don't need no %^$#(& MRI..."

Yow!  Getting your medical device from a welder?   

--Yevaud

[skeptigirl]

Eeek... I'm sorry but I must correct you all here.

First, who am I to be so bold? I am a Nurse Practitioner. I specialize in infectious diseases, and in particular, diseases workers are at risk of exposure to on the job. I have had my own practice in this field for close to 14 years. I know this field extremely well. Some of my clients are doctors who know to call me with their questions on vaccines, exposures, and a multitude of infectious diseases including influenza.

So, first point...is it an exaggeration to claim up to 100 million deaths in weeks? Well, here are some facts for you to draw your own conclusions.

In 1918, a similar flu killed between 20 and 40 million people in 4 months time. It returned the following year and killed another 5 million then seems to have disappeared. At that time there were troop movements to carry the virus from continent to continent. Today we have jets that move many more people to many more countries in hours.

We have been following this particular flu since 1997 when it first appeared in Hong Kong. It is called HPH5N1 for highly pathogenic avian flu H5N1. It is extremely lethal to poultry. When it first appeared > 30% of the humans known to be infected died. Most were previously young and healthy.

In the past 12 months we have seen a widespread outbreak of this flu strain in much of SE Asia. All efforts to contain it have failed. It has spread to many more mammals including 40 or so tigers in a zoo that died after being fed raw infected chickens, pigs that we believe may be the precursor to human and avian flu co-mixing of genes, herons, ducks, and other migrating birds as well as pigeons and birds that were intercepted being smuggled between countries.

This winter, of all the known cases in humans 70% have died. The real death rate is being assessed by sampling larger groups for antibodies to determine the real rate of infection so we have a more accurate denominator. That data is not in. Again, the deaths have been in previously healthy persons of all ages but many were young.

We have no vaccine for HPH5N1 and are having trouble producing one though I understand there may be a vaccine in clinical trials with animals. The current method of vaccine production involves inoculating large numbers of chicken eggs with live virus to produce quantities that are needed. The end product contains no live virus.

This means even if a vaccine is developed, current production methods may still have to be changed. Right now, the virus kills the eggs so manufacturers cannot use their normal production methods. In addition, while viruses are handled carefully in these facilities, the recent experience with Chiron's failures is cause for concern. What if the company had been using a very lethal strain of virus? Could they keep their own staff from getting infected? Would the building become a source of spread? We don't have these answers yet.

If the virus jumps from birds to humans in a form that remains deadly and acquires the usual human strain contagiousness before we have a vaccine, the number of dead could be even be higher than 100 million. Remember, we have to develop a vaccine, mass produce it, distribute it and then vaccinate. And if we don't have enough, we aren't going to be able to say, "let's use it only on high risk people", because everyone will be high risk.


Now, was SARS as bad as first thought and does it compare to flu? Yes and no. SARS had an extremely high fatality rate. In addition, those who didn't die were severely ill on ventilators, in ICUs for weeks. It was extremely contagious as well and resulted in the deaths of hundreds of health care workers. These included workers in hospitals as modern as any in the US with ICU care no less than one would get here. The worst event like this in a US hospital in the past was a case of Lassa fever that resulted in the deaths of 29 health care workers in the 70s.  Nothing in modern day health care compares to SARS though flu may surpass SARS by far.

So why did SARS seem to be a threat that was overblown and/or fizzled? Because it was the first time we had put controls into practice world wide like we did. No one knew if it could be done because it never had before. Had those measures failed, one can only imagine.

It took months to identify the SARS virus. It took >5 years to discover the HIVirus in the mid 80s. The breakthroughs today in technology and cooperation between countries was phenomenal. China did try to cover up the outbreak at first. It's amazing they would be embarrassed by admitting the state of their health care system. But thanks to the Internet, doctors and other health care workers literally bypassed the government and got the information out themselves.

One final difference, with SARS, most patients were so ill they were easily identified and isolated. Had there been milder cases we probably would have had a much harder time stopping the outbreak. That will not be the case with flu.

As to contagiousness, SARS was highly contagious but it was droplet spread. That meant one could get infected from touching contaminated surfaces, then touching your mouth, nose or eyes, or you could catch it if you were very close to the patient or shared eating utensils or dishes. With flu, we will see true airborne spread where people on buses, planes, in markets and so on will be exposed to virus particles that drift in the air.

SARS was not over rated. We were just very good at stopping it. Flu will not be the same.


The last misinformation I want to correct is about flu vaccine. The flu kills on average 36,000 people in the US every year and sends many more to the hospital. While 90% of those are people over 65 and some of the remaining 10% have pre-existing health problems, healthy young people including children die or are hospitalized every year from flu. The vaccine, on the other hand, is very safe, does not make most people sick, and if we didn't have a shortage would be recommended for everyone.

Every year I fight the flu vaccine myths that never seem to go away despite access to all the information we have these days. Your immune system is not "better" than the vaccine because the vaccine creates an immune response specific to the virus that is circulating. The strains included are not "guessed". The virus is so potentially dangerous it is monitored around the world. As new strains emerge, we detect them. The vaccine takes several months to produce so occasionally the virus changes after manufacturing is started. Then we have a partial mismatch but not a full one because the vaccine still cover 2 other strains that will circulate that year. Every year the vaccine used is evaluated after the season is over. It prevents flu or modifies disease in 70-95% of those vaccinated.

I get my flu vaccine every year and give one to my son. With all med choices we weigh risk vs benefit. There is absolutely no question the flu vaccine benefit far exceeds its risks, and the flu risk by far exceeds any potential vaccine risk to anyone, healthy or not.

There, I think I covered everything.

[Orstio]

Now, was SARS as bad as first thought and does it compare to flu? Yes and no. SARS had an extremely high fatality rate.

I question the validity of the SARS fatality statistics.  Because the symptoms are so similar to those of the flu, how do we know that more people did not contract and survive SARS, and just not go to the doctor?  Even people who had SARS, and were just under observation, without treatment, managed to survive.  As I've said before, I don't go to the doctor each time I get the flu, and I know very few people, actually, who do.  It is only people who get very sick that end up seeking medical attention.  How many people contracted SARS, assumed it was the flu, and recovered normally?  We cannot ever truly know.  The data will always be skewed by reported cases.  There is no way to track unreported cases.

What I was questioning about SARS, actually, were the Canadian cases, which seemed to target a completely different demographic than SARS in Asia.

At any rate, even if the chicken flu may someday become a problem, and, as you say, we have no vaccine, what does it help to tell the general public?  And, more specifically, what does it help to tell the general public that "Up to 100-million people could die in weeks if a bird flu pandemic broke out"?  Certainly, releasing relevant (and factual) information to the medical profession is the right thing for them to do, but to release such statistics to the public can be nothing but fear-mongering.

If there were a vaccine, I could see how this statement may raise awareness, so that people could be proactive.  Because there is no vaccine, this doesn't raise awareness, it raises fear.

[skeptigirl]

Now, was SARS as bad as first thought and does it compare to flu? Yes and no. SARS had an extremely high fatality rate.

I question the validity of the SARS fatality statistics.  Because the symptoms are so similar to those of the flu, how do we know that more people did not contract and survive SARS, and just not go to the doctor?  Even people who had SARS, and were just under observation, without treatment, managed to survive.  As I've said before, I don't go to the doctor each time I get the flu, and I know very few people, actually, who do.  It is only people who get very sick that end up seeking medical attention.  How many people contracted SARS, assumed it was the flu, and recovered normally?  We cannot ever truly know.  The data will always be skewed by reported cases.  There is no way to track unreported cases.

Actually, a few others did have SARS as was shown when epidemiological studies were done in Guandong, Province, China where SARS first appeared. There was a small percentage of locals who had antibodies to SARS, 2 or 3% and a slightly higher percentage, 5% in the market workers who would have had closer contact with the suspected original source, Civet Cats. (The %s are by my memory and were close but may not be exact.) This tells us SARS probably emerged earlier and with perhaps some very minor further mutations began its more lethal course. Another possibility is that the first to be infected had some cross protection from previous exposures to other similar corona viruses since they had continual contact with the animal source.

Either way, and even if the Civet Cats weren't the original source, this pattern is consistent with what we know about disease epidemiology. The reason we are fairly certain the fatality rates were figured with the correct denominators is no further spread of disease occurred. There have been two laboratory sourced outbreaks since the last community case, and only 3 or so people were infected. If there were mild cases going undetected, we'd have seen case after case of severe disease still occurring.

What I was questioning about SARS, actually, were the Canadian cases, which seemed to target a completely different demographic than SARS in Asia.

In Toronto, sick persons were identified and isolated more readily. That meant the secondary cases were in health care workers and family members, again consistent with droplet spread and not airborne spread. In Taiwan there was an outbreak in a 38 story housing project. There was speculation it was spreading in leaking drainage pipes but it could just have easily been spread on other surfaces. The virus lives several days on surfaces so after confining all cases, it's possible all the environmental contaminants finally died.

Again, epidemiology is an advanced science. Worldwide resources and the best infectious disease spedrug spammerts addressed SARS in a big way. No one is guessing about what happened. We know what happened because advanced laboratory tests, spedrug spammerts and other resources were used.

At any rate, even if the chicken flu may someday become a problem, and, as you say, we have no vaccine, what does it help to tell the general public?  And, more specifically, what does it help to tell the general public that "Up to 100-million people could die in weeks if a bird flu pandemic broke out"?  Certainly, releasing relevant (and factual) information to the medical profession is the right thing for them to do, but to release such statistics to the public can be nothing but fear-mongering.

If there were a vaccine, I could see how this statement may raise awareness, so that people could be proactive.  Because there is no vaccine, this doesn't raise awareness, it raises fear.

We need to educate the public, not dole out tidbits in news sources. If we don't then folks will have all sorts of bad information to try to make sense of just as the posts in this thread attest to. So you are correct on one level.

Why tell everyone of the potential threat? So people are aware of the need to use adequate resources to address the threat.

My other goal is to raise the basic education level on infectious diseases in general.

It'd be nice if people had an idea how we know what we know so they weren't continually calling the information guess work and bunk.

Disease causing organisms evolved in this world with us. You can't magically overcome infection by taking vitamins and eating right. Obviously a healthy immune system helps, but we live the life we do today because of vaccines and anti-infectives, not because we eat right.

Vaccines are recommended by the CDC, (our public health department), after very thorough evaluation of the vaccine risk and the disease risk. If it's recommended it isn't because some drug company makes a profit. Though we do need to be vigilant in this area because the drug companies are showing their greedier side in squelching some bad outcome research on new drugs. The philosophy I have is take or prescribe an older drug if it works and use new ones only when there are no other options until the new one's been on the market long enough to establish a track record.

I have lots more but this is long enough as it is. I will say considering this is the information age and considering how much progress we've made in infectious diseases, instead of increased general knowledge on the subject, most people today have just put these hazards out to pasture. We are really only one step ahead of bacteria in our antibiotic reserves, and the next worldwide plague is a when not an if. It pays to know a little about infections and how they are spread so when the next 'big one' does arrive, we take effective action rather than foolish action.

[yale]

This is no BS.
This is a terrifying possibility:

=====================================

Bird flu pandemic is possible, CDC warns
Mutated virus a 'very high threat' in coming weeks, official says

The Associated Press
Updated: 7:19 a.m. ET Feb. 22, 2005 WASHINGTON

 - A bird flu virus may mutate to a human form that becomes as deadly as the ones that killed millions during three influenza pandemics of the 20th century.

Dr. Julie L. Gerberding, head of the Centers for Disease Control and Prevention, said Monday that scientists believe it is highly likely that the virus that has swept through bird populations in Asia will evolve into a pathogen deadly for humans.

“We are expecting more human cases over the next few weeks because this is high season for avian influenza in that part of the world,” Gerberding said in remarks at the national meeting of the American Association for the Advancement of Science.

Although cases of human-to-human transmission have been rare, “our assessment is that this is a very high threat” based on the known history of the flu virus, she said.

72 percent mortality rateIn Asia, there have already been a number of deaths among people who caught the flu from chickens or ducks. The mortality rate is very high — about 72 percent of identified patients, said Gerberding. There also have been documented cases of this strain of flu being transferred from person-to-person, but the outbreak was not sustained, she said.

The avian flu now spreading in Asia is part of what is called the H1 family of flu viruses. It is a pathogen that is notorious in human history.

“Each time we see a new H1 antigen emerge, we experience a pandemic of influenza,” said Gerberding. In 1918, H1 appeared and millions died worldwide. In 1957, the Asian flu was an H2, and the Hong Kong flu in 1968 was a H3.

There had been small appearances of the H1-type of avian viruses in other years, but nothing like the H5 now rampaging through the birds of Asia.

“We are seeing a highly pathogenic strain of influenza virus emerge to an extraordinary proportion across the entire western component of Asia,” she said. “The reason this is so ominous is because of the evolution of flu. ... You may see the emergence of a new strain to which the human population has no immunity.”

Getting ready for next year
Study already has shown that the virus can infect cats who can then infect other cats, which Gerberding said was “another harbinger” of the possibility of a human pandemic.

“The science here is all alerting us that we have a great deal to be concerned about,” she said.

The CDC chief said her agency is getting ready for a possible pandemic next year.

A special flu team, organized last year, continues to monitor the spread of the avian flu and to analyze the strains as they appear.

The government has ordered 2 million doses of vaccine that would protect against the known strains of avian flu. Gerberding said this would give manufacturers a head start on making the shots that would be needed to combat a full-blown epidemic of an H1-type of flu in this country.

CDC is also plugged into an international communication and monitoring system that, it is hoped, will give an early warning of the emergence of a deadly new flu.

[Yevaud]

All I have to say, Skeptigirl, is this is very worrisome, particularly for health care workers.

I worked for about 13 years as a Biomedical Engineer in a number of large institutions BWH, New England Medical, etc.), and one thing I remember clearly is that if there was a flu, cold, or URI going around, chances were everyone at work would contract it.  Hospitals are, after all, where these things concentrate, usually in a fairly virulent fashion.

Keep safe, and keep us informed, please!

--Yevaud

[skeptigirl]

SARS was particularly bad for health care workers. Around 60% of the victims were health care workers infected on the job. Flu is going to be EVERYBODY'S problem.

We have been watching this particular flu strain since 1997 when it was first seen in Hong Kong. It got a lot worse this year and is now almost certainly endemic (there is another word for this in animals, enzootic I think) in the bird populations in Asia. Any chance of snuffing it out are now pretty nil. In addition, it has spread to several other species or at least shown it has the capability of infecting several species.

All of this adds up to one more step toward becoming a human pandemic. And, by historical evidence we are overdue for the next avian flu virus to cross the species barriers and become the next pandemic. If this is the strain that does it next we could have a really bad situation on our hands.

Now, if that isn't bad enough, the vaccine manufacturers met last year in Europe and reported their assessment of the world's capacity to make vaccine. At maximum production they could make enough for 5% of the world's population, and that would still be 1-3 years off. We have one antiviral drug that currently is effective given drug resistance does not emerge and that drug is also in very short supply as it is made by one company and very few agencies have started to consider stockpiling it.

Our own CDC talks about stockpiling 2 million doses of a vaccine that may work, again it isn't certain. This is disgusting since that's about enough for the CDC and the federal government officials and their families. Am I cynical, yes.

The fatality rate won't likely be 70+% but even at 5% we are talking millions and millions of people. One need only look at the history of the 1918 flu pandemic to see what is possible. It was particularly fatal in young adults that year.

There is fairly close monitoring of the situation going on. Flu can break out suddenly. There's no guarantee, but we should have a few weeks notice that an outbreak has begun. For now it looks like it may be about one more year but don't hold me to it. Even the best experts have no way of knowing since we don't have any history with the kind of monitoring we have today. No one knew if it would take off in 1997 and we don't know if it will happen in 2005 either. We just see it getting more and more likely.

Not to be overly paranoid but it doesn't hurt to have food and water to hold up at home should you not want to go out and be exposed. That's really the only way at the moment anyone is going to be able to deal with this hazard if we don't have drugs or vaccine. A food supply (and maybe water but I don't think the taps are going to get shut off) is a good idea anyway for all sorts of potential disasters.

Myself, I have purchased a little Tamiflu but it is very expensive to stockpile and I don't recommend anyone get any unless they are very familiar with it's limited use. You literally have to start taking it on the first day you are ill for it to work. And it may be premature to get it just yet.