[crossposted from dailykos]
I noticed some news reports in the past few days highlighting the report released by attendees to a World Health Organization meeting on pandemic flu, which took place in Manila a week or two back. DemFromCT’s diary of May 7th at dailykos mentioned this meeting as upcoming.
The lowdown? Scientists are reiterating that there are signs that H5N1 flu is evolving and becoming more likely to cause a pandemic. Also of interest is that there is evidence that some H5N1 may be partially resistant to Tamiflu.
– Deadly bird flu infections are being seen in larger clusters of people — with a much wider age range — than ever before.
– The virus is changing in ways that suggest it may be adapting to humans.
– Also of concern is the revelation that one virus isolate was partially resistant to TamiFlu, the only effective treatment for human infection with type H5N1 bird flu.
(note … I searched for, but found no coverage in a diary of this report. Let me know if something already exists, and I’ll delete)
More below …
Evidence suggests (although is not conclusive, as noted below) that H5N1 has reached a stage in which it is one stage short on WHO’s six-stage scale of being able to cause pandemic:
The WHO lists six stages leading from the detection of a new flu virus in animals to a global human flu pandemic. So far, the H5N1 bird flu has been at stage 4: small, highly localized clusters of human infections.
At this stage, the virus cannot spread easily from person to person.
The new evidence suggests — but does not yet prove — that bird flu may be moving to stage 5. That would mean the virus is becoming increasingly better at person-to-person spread. When stage 6 is reached, there will be rapid human-to-human flu spread and pandemic flu.
It’s only a matter of time, says virologist Klaus Stöhr, PhD, DVM, project leader for the WHO Global Influenza Program.
“We are in a situation where we simply have to deal with uncertainties on when this will happen — not whether this will happen or not,” Stöhr said yesterday in a news conference. “We believe a pandemic will happen, but we don’t know when and also [we don’t know] the severity of the event.”
As Dr. Stöhr noted in a quote in DemFromCT’s diary, the cases of this flu seem to be getting milder, which paradoxically may make it far more dangerous. If I understand correctly, what this means is that if the virus is less lethal, it may be able to infect more people more quickly, who will remain out and about in the general population for longer, despite having contracted the disease. If it spreads quickly enough, despite being less likely to kill any one person who becomes infected, it could kill more people overall because of the vastly greater number of infections, and the inability of humanity to respond comprehensively to a fast-moving pandemic.
What could a fast-moving pandemic be like?
Osterholm notes that with current technology, it would take at least six months to start producing a vaccine — and two doses would be needed for protection. And as Stöhr notes, the virus would reach the U.S. within three months.
If the bird flu started a pandemic now, Osterholm wrote:
“We would be facing a 1918-like scenario. … We would have no surge capacity for health care, food supplies, and many other products and services. … We have no detailed plans for staffing the temporary hospitals that would have to be set up in high-school gymnasiums and community centers — and that might need to remain in operation for one to two years. … We have no way of urgently increasing production of critical items such as antiviral drugs, masks for respiratory protection, or antibiotics for the treatment of secondary bacterial infections. … Nor do we have detailed plans for handling the massive number of dead bodies that would soon exceed our ability to cope with them.”
To be sure, there’s tremendous uncertainty about whether the changes being observed in H5N1 flu in southeast Asia are indicative of imminent and commonplace human-to-human transmissibility. However, as a couple of UCSF researchers point out, great concern is appropriate, and planning for pandemic ASAP is crucial.
But Rutherford noted that no scientist can be sure whether what is being observed is the birth of a pandemic, or simply the normal behavior of avian flu strains that have never been observed so closely.
Dr. Larry Drew, director of the UCSF virology lab, said the WHO findings underscore the need for pandemic pplanning.
“This report may help to convince the necessary people that the threat is imminent,” he said. “Obviously,
vaccine development has to accelerate. … The most achievable goal is to rapidly build the worldwide stockpile of antiviral drugs, and a huge mobilization is needed to do this.”
My suggestion? The administration, while it fell short during the recent vaccine shortage, needs to play a lead role. That said, I’m not counting on a robust political response at the federal level (as a side note, however, I think much of CDC’s work kicks ass — e.g. clinicians can sign up for email updates on avian flu). So, I think each of us can help by:
- For U.S. residents, contacting our senators and representative, making the point that it’s essential we plan ahead and that the federal stockpiles of Tamiflu are insufficient (currently estimated at enough for 1% of citizens). CC them copies of the articles cited above. They may be able to get a better response out of the administration, if we push them. Outside of the U.S., planning seems to be going better in many of the industrialized countries, but it’d be worth contacting elected officials & parliamentarians wherever you live.
- Contact state/provincial/regional and local elected officials asking for same. New York City is beginnning to do planning of its own for pandemic flu. Other jurisdictions should follow suit. This will result in better coordination in the event of an outbreak, and localwork may also “trickle up” to kick national governments into doing more/better/sooner.
- LTEs would be an effective way to raise the profile of the situation. Searching on “avian flu” from news.google.com would provide ample background material to cite in a letter.
While nobody exactly what’ll happen when, scientists are starting to warn that some sort of flu pandemic is likely a matter of when, not if. There are plenty of unanswered (and as yet unanswerable) questions about how severe such a pandemic might be. On balance, though, I’d certainly prefer to see us err on the side of great caution when faced with a health risk like this.