I hope they throttle this in SE Asia.
Bird flu rivals SARS as a global threat By Madeline Drexler, Boston Globe
IN THE OTHERWISE dry lingo of public health, a wonderfully evocative word is used to describe impending tragedy. The word is "smolder," and in epidemiology it means the silent, treacherous spread of a brand-new influenza virus. The 1918-19 flu pandemic, which killed 50 million people in just a few months, likely smoldered in Asia (beyond the notice of Western war-making powers) for a year before it caught fire, seemingly at once, in every corner of the globe. This month officials of the World Health Organization announced -- without using the word -- that another potentially devastating flu virus may be smoldering in Asia. In the shadow of SARS, an outbreak of "bird flu" in Vietnam, Korea, Thailand, and Japan has been decimating chicken flocks.
When children started dying in Hanoi last October, the world was put on notice: Act now. So far, seven people are known to have died from the new infection, and at least five more deaths are suspected.
Today's avian influenza epidemic has many of the hallmarks of a 1997 bird flu outbreak in Hong Kong, which claimed six lives and sickened at least 18. In both cases, the viruses were the H5N1 subtype -- a highly mutable packet of DNA that has proven it can leap the species barrier and kill with astounding speed.
During the outbreak in 1997, public health officials were terrified that the novel poultry virus was on the verge of becoming human-adapted -- that is, capable of spreading person to person. If enough residents of Hong Kong had been exposed to enough sick birds, the virus could have perfected its lethality and blazed around the world in a matter of weeks, striking down millions.
That year, after a Christmas-time slaughter of birds in Hong Kong's poultry markets, researchers discovered that in fact the virus had already begun to adapt to human biology. Worse, it turned out to be even more deadly than scientists had perceived at the time. One researcher told me, "This is the most pathogenic virus that we know of." He didn't mean just among flu viruses; he meant compared with all viruses. Health officials tracking today's H5N1 virus fear a similarly potent transformation.
With a new bird flu in our midst, what should we do? If recent history has taught us anything, it's the need for swift and thorough public health action. The SARS epidemic (which has so far killed nearly 800 victims) proved that classical public health measures such as case detection, patient isolation, infection control, and contact tracing can save lives.
SARS also underscored the need for international cooperation and honest disease reporting, but those are trickier propositions. On the one hand, Chinese authorities' notorious reluctance to come clean about the infection strengthened international health regulations and country-to-country arrangements. The WHO's Global Outbreak Alert and Response Network -- a web of laboratories, epidemiologists, nongovernmental organizations, and even a 24/7 Web-crawling tool -- is continually expanding. In 2005, new regulations will theoretically give the agency authority to step in wherever it sees an infectious disease threat based on both governmental and nongovernmental sources of information.
But in real life, words on paper don't always translate into action, and the failures of recent history may be repeating themselves. SARS had "smoldered" for months in China's Guangdong Province before it sparked across national borders last year. Now, according to London's Daily Telegraph, international health officials suspect that the ongoing bird flu outbreak may have an outpost in southern China -- a historic launch pad for pandemic flu viruses -- and that health officials there have not revealed all that they know.
"China is refusing to play ball on this," a regional WHO official complains in the Jan. 18 article. "We need to get in there, and we need to know what is going on, but despite repeated requests, China has failed to be forthcoming."
"Smolder" may be a pretty word in poetry books but not in public health. New infections are always smoldering just out of sight, often when human and animal viruses meet and exchange genetic material. Cultural assists such as international travel, invasive medicine, and globalization of the food supply often clear paths for these agents to spread. Sometimes we're too late on the scene. By the time doctors took notice of AIDS in the early 1980s, millions were infected worldwide.
The WHO has called today's bird flu outbreak in Asia "unprecedented" in its scope and virulence. Only if health officials and governments act now will we douse this epidemic -- and the next -- before they catch fire.
Madeline Drexler, a former medical columnist for The Boston Globe Magazine, is author of "Secret Agents: The Menace of Emerging Infections."
© Copyright 2004 Globe Newspaper Company.
© Copyright 2004 The New York Times Company |