Colette Shade
Issue date: 2/17/09
Vermont Cynic: Why is avian flu (H5N1) considered such a threat?
Paul Auwaerter: Regular, so-called seasonal influenza, has a mortality rate of 2 percent or less.
Avian influenza mortality has exceeded 60 percent and is similar to the great 1918 influenza epidemic, in that this new strain has a predilection for younger adults compared to routine influenza that usually causes greatest problems at the extremes of life.
Although the number of avian influenza victims has been low worldwide apparently due to the rather inefficient human-to-human transmission, the greatest concern is that virus mutates slightly and that the spread becomes easy and similar to most respiratory viruses.
VC: UVM has a plan of action in the event of a flu pandemic. It includes such measures as canceling classes to reduce person-to-person contact, sending students home where possible and setting up emergency medical wards in the athletic complex. Is this a viable way to help prevent the spread of the illness?
PA: Although some limited data exists that closing schools might be helpful, there is not much evidence that limiting public gatherings and the like would be beneficial.
Younger, school-aged children appear to be most efficient at spreading respiratory viruses and closing schools could be associated with decreasing spread of infection; whether closing colleges would have the same effect is uncertain.
VC: The plan maps out a scenario down to the exact week when specific events will occur. Is it possible for experts to pinpoint the time each event will occur within a margin of a week? What is a realistic approach?
PA: Based on prior epidemics and mathematical models, one can hazard an educated guess for planning purposes; however, one can be fairly sure that, if such a pandemic were to occur, plans would need to be altered.
VC: Does Johns Hopkins have a similar plan of action?
PA: Almost every healthcare institution has a plan, and I believe most municipalities have tried to come up with some kind of plan as well as incorporating some dry runs and trials, examining essential health care personnel, essential municipal workers and so on.
Now, I do think that, unfortunately, we remain rather under-funded and under-prepared in the sense of performing drills to really anticipate how one is to respond to this.
The fundamental challenge has been that if people really become as ill as possible with something like avian influenza, it will probably overwhelm our healthcare system; there's only a small percentage of [the] necessary respiratory equipment.
So I think the societal judgment is that the risks are probably too small to justify the time and financial expenditure.
Whether this is wise or not we'll never know.
VC: Are there any other illnesses that are likely to create a pandemic? What are they?
PA: No one would have predicted at all that a coronavirus, which is a generally pedestrian infection that causes routine colds and bronchitis, would cause a severe problem.
But five, six years ago, SARS (Severe Adult Respiratory Syndrome) became a worldwide problem incredibly quickly, starting first in Southeast Asia and then spreading to other parts of the globe, including the North American continent.
So no one would have predicted the coronavirus, and I think probably there are other viruses that could similarly cause problems, especially in this age where there's very efficient and quick transportation across the world.
I think people are looking at influenza because, historically, that is the one that has caused the most trouble. But SARS caught many people by surprise.
However, there were very good lessons to be learned, and the experience in Toronto, specifically, taught people quite a bit about how to handle such severe and sudden respiratory infections capable of killing people.
Now, the Ontario Healthcare Commission had a very large report that was issued, and, interestingly, the report was very critical, because of course there were lessons learned, yet many of those lessons had not really been applied to help prevent the next problem.
And this is an issue where you don't have a problem at hand; it takes a considerable amount of time and energy to really prepare to handle these things well, especially when it's not well known what or when this will happen.
So I think this a fundamental human nature issue, but certainly we can look to past experiences and those can help in terms of some preparation and planning.
VC: In the event of a pandemic, which areas of the nation and the world are likely to be hit the hardest?
PA: I'm not certain of anyone who can really predict that.
What's interesting about the 1918 epidemic of influenza is its propensity to affect relatively young people, whereas traditional seasonal influenza tends to be most severe in the very young as well as elderly people. That is not the case for these strains.
So one could say that perhaps younger populations might be affected. There's a concern, and I think that's why educational institutions - colleges, universities - are perhaps paying a bit more attention to pandemic planning because of how this seems to affect younger populations, at least in 1918.
Whether this will be the case in the future is unknown. And many people have wondered whether a transformative future strain of virus will act specifically on younger populations - 20-year-olds, 30-year-olds as occurred in 1918-or whether the apparent targeting of younger adults had more to do with the great army movements in Europe of World War I.
VC: When, if ever, do you think our next pandemic will occur?
PA: I think if you look historically, some have been surprised we have not had one to date. The last was over 40 years ago, in 1968, and previous epidemics have occurred, for example, every 10-20 years, so some say we are quite overdue for experiencing a pandemic, since one occurred in 1957 and 1968, but we've really not had one of a significant degree since.
VC: Pandemic avian flu is a very frightening subject to most people. Is there anything students can do to protect themselves?
PA: In terms of protection, there's really nothing that students probably need to do at the moment, other than not spend a lot of time in domestic husbandry, such as keeping ducks and geese in their dormitory rooms. However, for the people that truly wish to be prepared, keeping some fitted N95 masks - the kind of masks that have been proven to help limit the spread of most respiratory viruses - could be helpful. These are masks that are actually sold in home improvement stores because they're also very effective against inhaling paint particles.
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