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Where Has Bird Flu Flown?

Marc Siegel, MD
Medical Progress Today
February 23, 2007

A year ago at this time, I was one of many experts pontificating about H5N1 bird flu in print and on TV. Many were predicting that we were on the verge of a massive pandemic and we were unprepared for it. While I was also emphasizing the fact that we used out dated vaccines for flu and didn't have a hospital surge capacity if a pandemic did come, I was also concerned that we were focusing too much on the worst case scenario and gearing up for a risk that was remote.

The statistics bore me out. An AP/IPSOS poll last Spring reported that 35% of Americans believed that either they or a close relative was going to be infected by H5N1 sometime soon. This poll hasn't been repeated this year, but the numbers would surely be much lower as bird flu has flown from the U.S. news cycle.

Public health needs a new language to communicate risk that isn't as reliant on the news of the day or heavily weighted towards the worst case. The batting average for predicting disaster is quite low, and the public may be starting to become wise to it. Post-9/11, the American public feels more vulnerable to threats, and since 2001, there has been a parade of health scares that have fed on this overall fear, from anthrax in 2001 to smallpox in 2002 to SARS in 2003 to Mad Cow Disease in 2004, to bird flu in 2006.

Long term preparation is more efficient when it isn't tied to hype, because if you tell the public that doom is near in order to get their attention, they won't trust you when time passes and that disaster hasn't occurred. It is more honest to stick to the facts and limit speculation.

Here are the facts. The H5N1 bird flu is a massive killer of birds. Attempts to eradicate it in Asia have thus far failed, even as surveillance tests and bird vaccination and culling practices are expanding. The virus resides in bird gastrointestinal tracts and also invades their respiratory tracts, making them quite ill. Water fowl, mainly ducks, geese, and swans, can sometimes harbor H5N1 without becoming severely ill, but this flu is mostly fatal in poultry. In 2007, outbreaks of bird flu in poultry have occurred in Russia, Turkey, Pakistan, Indonesia, Hungary, Egypt, Nigeria, and throughout Southeast Asia. An infected turkey flock in the U.K. turned out to most likely be due to infected meat smuggled in from Hungary. Recent cases in humans (11) have occurred in Egypt, Indonesia, and Nigeria. The virus remains very difficult for humans to catch, and there have been fewer than 300 cases total in humans since 1997.

Studies completed over the past year have not been able to demonstrate the ability to manipulate H5N1's envelope proteins in the laboratory in order to render it more easily transmissible among humans. This is good news. We continue to be protected by a species barrier from this nasty bug. Despite how virulent this virus is, unless it changes significantly and adapts to humans, it will not cause our next pandemic. All the dramatic scare words have worn the public out. Time has passed, and the public has gotten used to the scare and is perhaps seeing the risk in better perspective.

This is no thanks to our public health officials who have risked public cynicism by too frequently sounding the public alarms too soon. Conventional wisdom among many of our "experts" is that a wake-up call to bird flu will result in improved preparedness even if a massive pandemic doesn't happen any time soon. But this assumes that short-term panic will somehow be converted to reasonable long-term planning. It is far more likely that we will see bird flu fatigue as a response to too much hype, and that enthusiasm for the whole topic of flu preparedness will wane. We are seeing some of this reaction already.

For example, last year's obsession with stock piles of the anti-viral Tamiflu was a waste of public emotion. This drug would have limited use even if a pandemic did occur because its effect on H5N1 is unproven and it would have to be used in a narrow window of time to be effective. Our energy is better spent pushing for a more integrated healthcare infrastructure on the local, state, and federal level with a built-in surge capacity to handle catastrophes. Instead of wildly speculating that this catastrophe will be a particular bird flu virus that currently has a very limited capacity to infect or kill us, we would be far better off with disaster planning in general. Put away a few months of food, water, and medication just in case of an emergency, but don't label this stash "for bird flu use only." If we make our planning more flexible and generic, we might be more capable of responding to an unpredicted catastrophe, rather than angling towards one whose chances are remote.

Instead of stockpiling vaccines made with a 50 year old method that slowly grows virus in chicken eggs, we can put more emphasis into upgrading how we make vaccines using cell culture medium and genetic technology. With more modern and rapidly produced vaccines, we would have the time to respond to an emerging virus rather than to have to try to blindly anticipate one. 1 billion dollars was budgeted last year for 5 manufacturers to create just this kind of vaccine—let's hope they succeed.

Last year's obsession with the supposed imminence of an H5N1 human pandemic has damaged public health credibility. We overreacted to the historical risk of a new flu strain once before in 1976, during the Swine flu fiasco when with the specter of the 1918 Spanish flu in their minds, 40 million people were hurriedly vaccinated against a flu that at most had killed a single military recruit. Almost a thousand cases of ascending paralysis appeared to result from that fiasco.

Before we make that kind of mistake again, it is this doctor's prescription that we use the current lull in bird flu news to reflect on our on-again off-again media-driven response to this type of theoretical health threat. If this bird flu is truly going to lead us to a stronger safety net in the future then it must do so rationally, without hype or fear.


Marc Siegel MD is an internist and associate professor of medicine at the NYU School of Medicine. He writes the Unreal World column for the LA Times Health section, is a frequent contributor to the Washington Post and NY Post, and is a member of the board of contributors at USA Today. He is the author of False Alarm: The Truth About the Epidemic of Fear and Bird Flu: Everything You Need to Know About the Next Pandemic.

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