Virus Poses Risk of Massive Casualties Around the World
Sep. 16, 2005 - It could kill a billion people
worldwide, make ghost towns out of parts of major cities, and there is
not enough medicine to fight it. It is called the avian flu.
This week, the U.S. government agreed to stockpile $100 million
worth of a still-experimental vaccine, while at the United Nations
Summit in New York, both the head of the U.N. World Health Organization
and President Bush warned of the virus' deadly potential.
"We must also remain on the offensive against new threats to public
health, such as the Avian influenza," Bush said in his speech to world
leaders. "If left unchallenged, the virus could become the first
pandemic of the 21st century."
According to Dr. Irwin Redlener, director of the National Center for
Disaster Preparedness at Columbia University's Mailman School of Public
Health, Bush's call to remain on the offensive has come too late.
"If we had a significant worldwide epidemic of this particular
avian flu, the H5N1 virus, and it hit the United States and the world,
because it would be everywhere at once, I think we would see outcomes
that would be virtually impossible to imagine," he warns.
Already, officials in London are quietly looking for extra morgue space
to house the victims of the H5N1 virus, a never-before-seen strain of
flu. Scientists say this virus could pose a far greater threat than
smallpox, AIDS or anthrax.
"Right now in human beings, it kills 55 percent of the people
it infects," says Laurie Garrett, a senior fellow on global health
policy at the Council on Foreign Relations. "That makes it the most
lethal flu we know of that has ever been on planet Earth affecting
human beings."
No Natural Immunity
The Council on Foreign Relations
devoted its most recent issue of the prestigious journal, Foreign
Affairs, to what it called the coming global epidemic, a pandemic.
"Each year different flus come, but your immune system says, 'Ah, I've
seen that guy before. No problem. Crank out some antibodies, and I
might not feel great for a couple of days, but I'll recover,'" Garrett
says. "Now what's scaring us is that this constellation of H number 5
and N number 1, to our knowledge, has never in history been in our
species. So absolutely nobody watching this has any natural immunity to
this form of flu."
Like most flu viruses, this form started in wild birds -- such as geese, ducks and swans -- in Asia.
"They die of a pneumonia, just like people," says William Karesh, the
lead veterinarian for the Wildlife Conservation Society. "When you open
them up, you do a post-mortem exam. Their lungs are just full of fluid
and full of blood."
Karesh has been tracking this flu strain for the last several years as
it has gained strength, spreading from wild birds to chickens to
humans.
"We start at a market somewhere in Guangdong Province in China,"
explains Karesh. "And it's packed with cages, and you'll have chickens,
and you'll have ducks. You might have some other animals -- cats, dogs,
turtles, snakes -- and they're all stacked in cages, and they're all
spreading their germs to each other."
In response, Asian governments have killed millions of chickens in futile attempts to stop the flu's spread to humans.
"The tipping point, the place where it becomes something of an
immediate concern, is where that virus changes, we call it mutates, to
something that is able to go from human to human," says Redlener,
director of the National Center for Disaster Preparedness.
Echoes of the 'Spanish Flu' Epidemic
Scientists in Asia and around the world are now working around the clock as they wait for that tipping point.
"Unlike the normal human flu, where the virus is predominantly in the
upper respiratory tract so you get a runny nose, sore throat, the H5N1
virus seems to go directly deep into the lungs so it goes down into the
lung tissue and causes severe pneumonia," says Dr. Malik Peiris, the
scientist who first discovered the so-called SARS virus, which killed
700 people and drew worldwide attention.
To date, there have been 57 confirmed human deaths, and another
suspected one last week in Indonesia. Scientists say the humans have
only been infected by birds. However, they add, every infected person
represents one step closer to the tipping point.
"Once that virus is capable of not needing the birds to infect humans,
then we have the beginnings of what can turn out to be this worldwide
epidemic problem that the experts call 'pandemics,'" Redlener says.
That is exactly what happened in 1918 when the global epidemic called the Spanish flu struck.
"The Spanish flu was killing people in two or three days once they got
sick," said Bill Karesh of the Wildlife Conservation Society.
"In 1918, my now-quite-elderly uncle was a young boy, living in
Baltimore, Maryland," says Garrett of the Council on Foreign Relations.
"And the flu came through, and his family insisted that he could not go
outside for any reason until the whole epidemic was over. He spent
afternoons looking out the window and counting the hearses going up and
down the neighborhood and trying to guess which of his schoolmates had
died."
Disaster Would Require Massive Quarantines
Unlike the avian flu, the Spanish flu spread long before the
international air travel routes of today. At that time, there were no
nonstop flights from flu ground zero to the United States. But not
anymore.
Karesh believes the avian flu could travel from China to Japan to New York to San Francisco within the first week.
"It's on people's hands. You shake hands. You touch a doorknob that
somebody recently touched," Garrett says, referring to how the flu is
spread.
Redlener, who is stationed at Mailman School of Public Health at
Columbia University, has been working with New York City officials to
get ready for the deadly epidemic.
"The city would look like a science fiction movie," according to him.
"It's extremely possible we'd have to quarantine hospitals. We'd have
to quarantine sections of the city."
"I could imagine that you could look at Grand Central Station and not
see much of anybody wandering around at all," Garrett agrees. "People
would be afraid to take the subways, because who wants to be in an
enclosed air space with a whole lot of strangers, never knowing which
ones are carrying the flu?"
As for the hospitals, there would be scenes like the ones this past
month in the stadiums of New Orleans and Houston after Hurricane
Katrina.
"There wouldn't be equipment and personnel to staff them adequately
that you could really call them a hospital," Garrett predicts. "You
might more or less call them warehouses for the ailing."
And, as happened in New Orleans, there would be no place for the dead.
"If you look at the expected number of deaths that could occur in
cities across the United States, we are wholly unprepared to process
those bodies in a dignified and respectful way," asserts Michael
Osterholm, director of the Center for Infectious Disease Research and
Policy. "We will run out of caskets literally within days."
The prospects have become so bleak that in planning meetings held in
New York City, veteran emergency responders have walked away.
"They just don't know how we're going to get through," says Osterholm
of those responders. "If we have a repeat of the 1918 life experience,
I can't imagine anything to be closer to a living hell than that
experience of 12 to 24 months of pandemic influenza."
If the flu does strike, victims at first would not know if it is the
kind of easily treated flu that comes every year or the killer flu,
known as H5N1.
The man in charge of making sure Americans are prepared in the event of
a killer flu epidemic is the secretary of Health and Human Services.
"We would do all we could to quarantine," says Secretary Michael
Leavitt. "It's not a happy thought. It's something that keeps the
president of the United States awake. It keeps me awake."
The preparedness plan calls for Leavitt to run operations out of a crisis room in Washington.
When pressed as to how ready the country actually is, Leavitt replied,
"Not as prepared as we need to be. We're better prepared than we were
yesterday; we'll be better prepared tomorrow than we are today."
The draft report of the federal government's emergency plan, obtained
and examined by ABC News' "Primetime," predicts as many as 200,000
Americans will die within a few months. This is considered a
conservative estimate.
"The first thing is everybody in America's going to say, 'Where's the
vaccine?' And they're going to find out that it's really darned hard to
make a vaccine. It takes a really long time," said Garrett of the
Council on Foreign Relations.
In fact, the draft report says it will not be until six months after
the first outbreak that any vaccine will be available, and then only in
a limited supply.
"I imagine that not a lot of poor people will get vaccinated," Garrett
says. "If you think about New Orleans, this is a similar situation."
'Inadequate' Stockpile of Medicine
While there is no vaccine to stop the flu, there is one medicine to
treat it. Called Tamiflu, it is made by the Roche pharmaceutical
company in Switzerland. Roche has been selling Tamiflu for years.
Only recently, however, did scientists learn of its potential to work
against the killer flu, H5N1. That has since created a huge demand and
a critical shortage.
"All of the wealthiest countries in the world are trying to purchase
stockpiles of Tamiflu," says Garrett. "Our current stockpile is around
2.5 million courses of treatment."
According to Leavitt, that is a long way from the country's ideal
stockpile. "Our objective is to have 20 million doses of Tamiflu or
enough for 20 million people," he says.
He later admitted that only 2 million are currently on hand, but asserted that no other country is in a better position.
Officials in Australia, however, have 3.5 million courses of treatment,
and in Great Britain, officials say they have ordered enough to cover a
quarter of their population.
"I think at the moment, with 2.5 million doses, you are pretty
vulnerable," warns professor John Oxford of the Royal London Hospital.
"The lack of advanced planning up until the moment in the United
States, in the sense of not having a huge stockpile I think your
citizens deserve, has surprised me and has dismayed me," he admits.
Faced with worldwide demand, the Roche company, which produces Tamiflu,
has organized a first-come, first-served waiting list. The United
States is nowhere near the top.
"The way we are approaching the discussions with governments is that we
are operating on a first-come, first-serve basis," says Dr. David
Reddy, head of the pandemic task force at Roche.
"Do we wish we had ordered it sooner and more of it? I suspect one
could say yes," admits Leavitt. "Are we moving rapidly to assure that
we have it? The answer is also yes."
When asked why the United States did not place its orders for Tamiflu
sooner, Leavitt replied, "I can't answer that. I don't know the answer
to that."
Even leading Republicans in Congress say the Bush administration has not handled the planning for a possible flu epidemic well.
Senate Majority Leader Bill Frist, R-Tenn., says the current Tamiflu stockpile of 2 million could spell disaster.
"That's totally inadequate. Totally inadequate today," says Frist, who
is also a physician. "The Tamiflu is what people would go after. It's
what you're going to ask for, I'm going to ask for, immediately."
Leavitt says deciding who gets the 2.5 million doses of Tamiflu
currently on hand in the United States is part of the federal
government's response plan. However, he also admits that thought has
motivated the government to move rapidly in securing more doses of the
medicine.
"It isn't going to happen tomorrow, but if it happened the day after
that, we would not be in as good as a position as we will be in six
months," he says.
However, in the end, even the country's top health officials concede
that a killer flu epidemic this winter would make the scenes of Katrina
pale in comparison.
"You know, I was down in New Orleans in that crowded airport now a
couple weeks ago," Frist says. "And this could be not just equal to
that, but many multiple times that. Hundreds of people laid out, all
dying, because there was no therapy. And a lot of people don't realize
for this avian flu virus, there will be very little effective therapy
available early on."
