As flu season arrives in North America, the media and their anointed health experts are squawking once again about how we could be blindsided by an avian flu pandemic that some have estimated could kill a billion persons worldwide. New books like The Coming Avian Flu Pandemic join last year's The Monster at Our Door: The Global Threat of Avian Flu. A year ago I wrote in the Weekly Standard that it was time to stop running around like chickens with their heads cut off. Yet even as conservative commentator Mark Helprin has called for spending a massive 2.5 percent of the federal budget to stave off this will o' the wisp, the case against panic is clearer than ever.
While doomsayers with extremely old wall calendars continue to invoke the devastating 1918-1919 Spanish flu pandemic as a model, they continue to ignore some rather important developments since then. That includes antibiotics to treat the secondary infections that then, as now, are the ultimate cause of most flu deaths. Better nourishment alone would dramatically reduce the death rate -- even if we're actually quite over-nourished. That's why a recent widely misinterpreted medical journal article said that if there were a repeat of the Spanish flu that 96 percent of the deaths would be in the developing world. Alarmists also ignore the introduction of antivirals, developments in flu vaccine production, and recent studies and observations that show avian influenza type H5N1 is neither as contagious nor as deadly as they claim.
Start with the last.
We're warned that H5N1 in birds is mutating like gangbusters and therefore any day may mutate to become readily transmissible from human to human. Or it may "reassort," meaning that it could mix with human flu in an animal or human and emerge with the worst aspects of both. But H5N1 was first discovered in Scottish chickens in 1959 and has therefore had almost half a century to do either. Theoretically it still could; but it won't be tomorrow and quite possibly never.
Indeed, reassortment may be no threat whatsoever. A study using one of the few animal species that contracts human flu, ferrets, appeared in the August 8, 2006 issue of Proceedings of the National Academy of Scientists. The ferrets were infected with several H5N1 strains in addition to a common human influenza virus that circulates almost every year. The infected animals were then either placed in the same cage with uninfected ferrets to test transmissibility by close contact or in adjacent cages with perforated walls to test spread of the virus from respiratory droplets. None of the secondary ferrets received either a reassorted virus or even the H5N1, thereby mimicking what we've seen in humans.
Separately, the scientists used gene splicing to create a hybrid virus. They found these hybrids also did not pass easily between the animals. Moreover, ferrets injected with the reassorted virus symptoms were less severe than with those who received pure H5N1. Reassortment appears to have weakened the germ.
How about all the talk of H5N1 having a death rate above 50 percent? This is based on a readily-dismissible artifact: The numbers come from that tiny subset of persons whose flu symptoms are so severe that go to the hospital -- Third World hospitals with Third World medicine, at that. To find a true death rate, researchers studied residents in a rural district in Vietnam and published their results in the January 2006 in the Archives of Internal Medicine. They found a mortality rate for those infected with avian flu of about one in 140 or 0.71 percent -- about the same as seasonal human flu.
Assuming H5N1 did become pandemic, we are now building huge stockpiles of two antivirals -- Tamiflu and Relenza -- that appear they could be tremendously effective against avian flu H5N1 because they specifically target neuraminidase (the "N" part of the name.) Research at St. Jude's Research Hospital has shown that H5N1 appears to express the highest level of neuraminidase of any flu since 1957.
Other studies show the drugs can effectively kill two birds with one stone by both preventing a person from getting the flu or, if they do get it, from transmitting it.
A review of four of them in the American Journal of Epidemiology showed that preventative administration of Relenza reduced the chance of becoming infected by 75 percent, reduced the chance of transmission by 19 percent, and reduced the severity of illness by 52 percent. For Tamiflu preventative administration reduced the chance of becoming infected by 81 percent, reduced the chance of by transmission by 80 percent, and reduced the severity of illness by 56 percent.
Meanwhile, at least six different drug companies have vaccines for H5N1 in testing or even in production while awaiting regulatory approval. At least one country has ordered enough for every citizen. The focus in developing these vaccines is making them in cell cultures rather than eggs. This could reduce the time needed to create them from the present 9-month period to just 90 days. A pneumonia vaccine has already been available for decades, and pneumonia is by far the greatest killer of flu victims.
Every day that passes doesn't bring us a closer to a pandemic. It does bring us closer to having ever larger and more-effective stockpiles of drugs to both prevent and treat avian flu in the highly unlikely event there is pandemic.
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