>> Stratfor: Special Report - October 24, 2005
>>
>>
>> Special Report: The Bird Flu and You
>>
>> Stratfor subscribers have been sending us a steady
>> river of requests
>> for our opinion on the bird flu situation. Although
>> we are not medical
>> experts, among our sources are those who are. And
>> here is what we have
>> been able to conclude based on their input and our
>> broader analysis of
>> the bird flu threat:
>>
>> Calm down.
>>
>> Now let us qualify that: Since December 2003, the
>> H5N1 bird flu virus
>> -- which has caused all the ruckus -- has been
>> responsible for the
>> documented infection of 121 people, 91 one of whom
>> caught the virus in
>> Vietnam. In all cases where information on the chain
>> of infection has
>> been confirmed, the virus was transmitted either by
>> repeated close
>> contact with fowl or via the ingestion of
>> insufficiently cooked
>> chicken products. In not a single case has
>> human-to-human
>> communicability been confirmed. So long as that
>> remains the case,
>> there is no bird flu threat to the human population
>> of places such as
>> Vietnam at large, much less the United States.
>>
>>
>>
>> The Politics of Genetics
>>
>> An uncomfortable but undeniable fact is that there
>> are a great many
>> people and institutions in this world that have a
>> vested interest in
>> feeding the bird flu scare. Much like the "Y2K" bug
>> that commanded
>> public attention in 1999, bird flu is all you hear
>> about. Comparisons
>> to the 1918 Spanish influenza have produced death
>> toll projections in
>> excess of 360 million, evoking images of chaos in
>> the streets.
>>
>> One does not qualify for funding -- whether for
>> academic research,
>> medical development or contingency studies -- by
>> postulating about
>> best-case scenarios. The strategy is to show up
>> front how bad things
>> could get, and to scare your targeted benefactors
>> into having you
>> study the problem and manufacture solutions.
>>
>> This hardly means that these people are evil, greedy
>> or irresponsible
>> (although, in the case of Y2K or when a health
>> threat shuts down
>> agricultural trade for years, one really tends to
>> wonder). It simply
>> means that fear is an effective way to spark
>> interest and action.
>>
>> Current medical technology lacks the ability to cure
>> -- or even
>> reliably vaccinate against -- highly mutable viral
>> infections; the
>> best available medicines can only treat symptoms --
>> like Roche's
>> Tamiflu, which is becoming as scarce as the
>> oftentimes legendary red
>> mercury -- or slow a virus' reproduction rate. Is
>> more research
>> needed? Certainly. But are we on the brink of a
>> cataclysmic outbreak?
>> Certainly not.
>>
>> A bird flu pandemic among the human population is
>> broadly in the same
>> category as a meteor strike. Of course it will
>> happen sooner or later
>> -- and when it does, watch out! But there is no --
>> absolutely no --
>> particular reason to fear a global flu pandemic this
>> flu season.
>>
>> This does not mean the laws of nature have changed
>> since 1918; it
>> simply means there is no way to predict when an
>> animal virus will
>> break into the human population in any particular
>> year -- or even if
>> it will at all. Yes, H5N1 does show a propensity to
>> mutate; and, yes,
>> sooner or later another domesticated animal disease
>> will cross over
>> into the human population (most common human
>> diseases have such
>> origins). But there is no scientifically plausible
>> reason to expect
>> such a crossover to be imminent.
>>
>> But if you are trying to find something to worry
>> about, you should at
>> least worry about the right thing.
>>
>> A virus can mutate in any host, and pound for pound,
>> the mutations
>> that are of most interest to humanity are obviously
>> those that occur
>> within a human host. That means that each person who
>> catches H5N1 due
>> to a close encounter of the bird kind in effect
>> becomes a sort of
>> laboratory that could foster a mutation and that
>> could have
>> characteristics that would allow H5N1 to be
>> communicable to other
>> humans. Without such a specific mutation, bird flu
>> is a problem for
>> turkeys, but not for the non-turkey farmers among
>> us.
>>
>> But we are talking about a grand total of 115 people
>> catching the bug
>> over the course of the past three years. That does
>> not exactly produce
>> great odds for a virus -- no matter how genetically
>> mutable -- to
>> evolve successfully into a human-communicable
>> strain. And bear in mind
>> that the first-ever human case of H5N1 was not in
>> 2003 but in 1997.
>> There is not anything fundamentally new in this
>> year's bird flu scare.
>>
>> A more likely vector, therefore, would be for H5N1
>> to leap into a
>> species of animal that bears similarities to human
>> immunology yet
>> lives in quarters close enough to encourage viral
>> spread -- and lacks
>> the capacity to complete detailed questionnaires
>> about family health
>> history.
>>
>> The most likely candidate is the pig. On many farms,
>> birds and pigs
>> regularly intermingle, allowing for cross-infection,
>> and similar
>> pig-human biology means that pigs serving in the
>> role as mutation
>> incubator are statistically more likely than the odd
>> Vietnamese
>> raw-chicken eater to generate a pandemic virus.
>>
>> And once the virus mutates into a form that is
>> pig-pig transferable, a
>> human pandemic is only one short mutation away. Put
>> another way, a
>> bird flu pandemic among birds is manageable. A bird
>> flu pandemic among
>> pigs is not, and is nearly guaranteed to become a
>> human pandemic.
>>
>> Pandemics: Past and Future
>>
>> What precisely is a pandemic? The short version is
>> that it is an
>> epidemic that is everywhere. Epidemics affect large
>> numbers of people
>> in a relatively contained region. Pandemics are in
>> effect the same,
>> but without the geographic limitations. In 1854 a
>> cholera epidemic
>> struck London. The European settling of the Americas
>> brought disease
>> pandemics to the Native Americans that nearly
>> eliminated them as an
>> ethnic classification.
>>
>> In 1918 the influenza outbreak spread in two waves.
>> The first hit in
>> March, and was only marginally more dangerous than
>> the flu outbreaks
>> of the previous six years. But in the trenches of
>> war-torn France, the
>> virus mutated into a new, more virulent strain that
>> swept back across
>> the world, ultimately killing anywhere from 20
>> million to 100 million
>> people. Some one in four Americans became infected
>> -- nearly all in
>> one horrid month in October, and some 550,000 --
>> about 0.5 percent of
>> the total population -- succumbed. Playing that
>> figure forward to
>> today's population, theoretically 1.6 million
>> Americans would die.
>> Suddenly the fear makes a bit more sense, right?
>>
>>
>> Wrong.
>>
>> There are four major differences between the 1918
>> scenario and any new
>> flu pandemic development:
>>
>> First -- and this one could actually make the death
>> toll higher -- is
>> the virus itself.
>>
>> No one knows how lethal H5N1 (or any animal
>> pathogen) would be if it
>> adapted to human hosts. Not knowing that makes it
>> impossible to
>> reliably predict the as-yet-unmutated virus'
>> mortality rate.
>>
>> At this point, the mortality rate among infected
>> humans is running
>> right at about 50 percent, but that hardly means
>> that is what it would
>> look like if the virus became human-to-human
>> communicable. Remember,
>> the virus needs to mutate before it is a threat to
>> humanity -- there
>> is no reason to expect it to mutate just once. Also,
>> in general, the
>> more communicable a disease becomes the lower its
>> mortality rate tends
>> to be. A virus -- like all life forms -- has a
>> vested interest in not
>> wiping out its host population.
>>
>> One of the features that made the 1918 panic so
>> unnerving is the "W"
>> nature of the mortality curve. For reasons unknown,
>> the virus proved
>> more effective than most at killing people in the
>> prime of their lives
>> -- those in the 15- to 44-year-old age brackets.
>> While there is no
>> reason to expect the next pandemic virus to not have
>> such a feature,
>> similarly there is no reason to expect the next
>> pandemic virus to
>> share that feature.
>>
>> Second, 1918 was not exactly a "typical" year.
>>
>> World War I, while coming to a close, was still
>> raging. The war was
>> unique in that it was fought largely in trenches,
>> among the least
>> sanitary of human habitats. Soldiers not only faced
>> degrading health
>> from their "quarters" in wartime, but even when they
>> were not fighting
>> at the front they were living in barracks. Such
>> conditions ensured
>> that they were: a) not in the best of health, and b)
>> constantly
>> exposed to whatever airborne diseases afflicted the
>> rest of their
>> unit.
>>
>> As such, the military circumstances and style of the
>> war ensured that
>> soldiers were not only extraordinarily susceptible
>> to catching the
>> flu, but also extraordinarily susceptible to dying
>> of it. Over half of
>> U.S. war dead in World War I -- some 65,000 men --
>> were the result not
>> of combat but of the flu pandemic.
>>
>> And it should be no surprise that in 1918,
>> circulation of military
>> personnel was the leading vector for infecting
>> civilian populations
>> the world over. Nevertheless, while the United
>> States is obviously
>> involved in a war in 2005, it is not involved in
>> anything close to
>> trench warfare, and the total percentage of the U.S.
>> population
>> involved in Iraq and Afghanistan -- 0.005 percent --
>> is middling
>> compared to the 2.0 percent involvement in World War
>> I.
>>
>> Third, health and nutrition levels have radically
>> changed in the past
>> 87 years. Though fears of obesity and insufficient
>> school lunch
>> nutrition are all the rage in the media, no one
>> would seriously
>> postulate that overall American health today is in
>> worse shape than it
>> was in 1918. The healthier a person is going into a
>> sickness, the
>> better his or her chances are of emerging from it.
>> Sometimes it really
>> is just that simple.
>>
>> Indeed, a huge consideration in any modern-day
>> pandemic is
>> availability of and access to medical care. Poorer
>> people tend to live
>> in closer quarters and are more likely to have
>> occupations (military,
>> services, construction, etc.) in which they
>> regularly encounter large
>> numbers of people. According to a 1931 study of the
>> 1918 flu pandemic
>> by the U.S. Public Health Service, the poor were
>> about 20 percent to
>> 30 percent more likely to contract the flu, and
>> overall mortality
>> rates of the "well-to-do" were less than half that
>> of the "poor" and
>> "very poor."
>>
>> But the fourth factor, which will pull some of the
>> strength out of
>> any new pandemic, is even more basic than starting
>> health:
>> antibiotics. The 1918 pandemic virus was similar to
>> the more standard
>> influenza virus in that the majority of those who
>> perished died not
>> from the primary attack of the flu but from
>> secondary infections --
>> typically bacteria or fungal -- that triggered
>> pneumonia. While
>> antibiotics are hardly a silver bullet and they are
>> useless against
>> viruses, they raise the simple possibility of
>> treatment for bacterial
>> or fungal illnesses. Penicillin -- the first
>> commercialized antibiotic
>> -- was not discovered until 1929, 11 years too late
>> to help when panic
>> gripped the world in 1918.
>>
>>
>> |
