SPECIAL REPORT:AVIAN FLU

Sunday, January 25, 2009

Why be scared, really, really scared

Full-blown outbreak ‘just a matter of time’

By Paul M. Icamina, Special Reports Editor IMAGINE: a veritable ghost town with deserted streets, most residents locked indoors fearful to venture outside, the schools, offices, banks, malls, public markets and groceries all shut down. A full-blown bird flu outbreak may create this scary scene. And it is not farfetched in the Philippines. Health Secretary Francisco Duque 3rd warns that it is “just a matter of time.” “In the worst scenario, public health measures will be instituted to prevent the spread of infection. These include suspension of public events, closure of schools and public establishments, reduction of unnecessary travel and for the ill to stay home,” the Department of Health (DOH) warns. “Essential services such as emergency and disaster response, maintenance of peace and order and transportation, water and electricity utilities should be maintained,” says Dr. Lyndon Lee Suy, head of the DOH Emerging and Re-Emerging Infectious Disease Program. “Duty schedules and buddy systems need to be planned.” “Widespread illness will occur. Large numbers of deaths will occur. Medical supplies will be inadequate,” the World Health Organization (WHO) warns. “Few countries have the staff, facilities, equipment and hospital beds needed to cope with large numbers of people who suddenly fall ill.” “Social and economic disruptions could be temporary but may be amplified in today’s closely interrelated and interdependent systems of trade and commerce. Social disruption may be greatest when rates of absenteeism impair essential services, such as power, transportation and communications.” The World Bank estimates a severe flu pandemic could cost $3 trillion and result in a drop of nearly 5 percent in world gross domestic product. Serious disruption It is not known how contagious and how virulent a pandemic, or worldwide, strain of bird flu might be. Nor is it known if it will happen at all. If it does, WHO estimates between 2 million and 7 million will be killed worldwide. The estimate is speculative—and conservative, based on the comparatively mild 1957 pandemic. In the 20th century, the influenza pandemic of 1918 to 1919—considered exceptional—caused about 40 to 50 million deaths worldwide. It was followed by pandemics in 1957 to 1958 and 1968 to 1969 that were considerably less serious. The previous pandemics encircled the globe in six to nine months, even when most international travel was by ship. Given the speed and volume of international air travel today, says WHO, the virus could spread more rapidly, possibly reaching all continents in less than three months. What is certain is that if a pandemic occurs today there will be serious disruption of normal life, with enormous strain on public health facilities and considerable economic loss, dwarfing SARS (Severe Acute Respiratory Syndrome) in casualties, social and economic impact. One possible scenario is that bird flu will render one-third of a country’s workforce sick, with another third too frightened to leave home. How then would authorities be able to ensure vital services such as clean water, sanitation, law and order and transport? What if bodies are piling up in morgues with no one on duty to dispose of them? Should schools be closed? How about offices and financial institutions? These are just a few of the issues governments now consider when they draw up pandemic preparedness plans. WHO believes there is still a window of opportunity to turn back the threat. But the situation is now beyond the control of any one country and needs a global response. Influenza pandemics occur, on average, three to four times each century when a new and highly transmissible virus emerges against which there is no immunity. Many experts agree that another influenza pandemic is due. Deadly strain A pandemic occurs when a new influenza virus emerges and starts spreading as easily as normal influenza—by coughing and sneezing. Because the virus is new, the human immune system will have no pre-existing immunity. This makes it likely that people who contract pandemic influenza will experience more serious disease than that caused by normal influenza. Most affected will be previously healthy children and young adults. While the virus does not jump easily from birds to humans or spread readily among humans, a pandemic could begin if the H5N1 virus that causes bird flu evolves to a form as contagious as normal influenza. The H5N1 strain has pandemic potential since it might ultimately adapt into a strain that is contagious among humans. Once this happens, it will no longer be a bird virus—it will be a human influenza virus. Vietnam believes its health-care system would be overwhelmed if 10 percent of its 82 million people became infected with bird flu. It will then declare a nationwide emergency. It can cope with a small-scale epidemic but if it turns into a pandemic, Vietnamese health authorities admit they will be almost helpless. After announcing four human infections in the last two weeks and two deaths this month, China’s Health Minister Chen Zhu warns the country faces “grim” prospects. The same could be true in the Philippines—if and when bird flu enters the country. Even if just 2 percent of the population is affected, that is already 1.78 million Filipino patients. Health facilities and manpower will be overwhelmed. Bird flu per se, says health authorities, is manageable. But a pandemic is another story.