France, Germany, the Czech Republic and possibly Austria are the latest EU countries to have a recurrence of H5N1 (bird flu) in wild birds or domestic poultry. Last year also saw many EU countries afflicted, but until the UK turkey outbreak in February (see here, here, here and here) some hoped it wouldn't come back. Now it is spreading again. No surprise, really. Wherever and however it finds a place in birds it seems very hard, if not impossible, to eradicate permanently.
That, of course, is the problem. Let's forget about the argument as to whether a pandemic is "inevitable" because pandemics happen. I've never found that a good argument, although it is true flu pandemics have occurred at irregular intervals for as long as we have been able to detect them. The biology pretty much explains why we have had this, although not sufficiently to be able to predict when another will occur or with what strain. Whether the future will look like the past or even what the past has looked like remain matters of some uncertainty. I don't need that argument to be concerned. Because of the birds.
The problem, again, is that we have a virus that naturally and persistently infects birds, both wild and domestic, that is capable of infecting humans, and when it does is very virulent (case fatality ratio above 60% as far as we can estimate at the moment). It is also a virus against which we have little or uncertain natural immunity. We can't easily control either the birds or infected people.
On the good side, most people appear not to be very susceptible to this virus, and perhaps this is the reason for its lack of transmissibility. We sometimes lose sight that there are many factors in the host-agent relationship that affect transmissibility. A virus that is not very infective might not be easily transmitted because it takes so much of the virus to cause an infection it rarely happens. But it might also be because currently very little of the virus is being shed. Or because most people aren't susceptible. Or still other reasons. At this point we don't know which of the many parts that could be involved are responsible for the lack of transmissibility or what it would take to alter that relatively happy circumstance. It's likely the virus could become more transmissible in any of a number of different ways.
The widespread prevalence of the virus in bird populations -- and who knows, perhaps other reservoirs we've never looked at -- means that it has many chances to experiment with new ways to make copies of itself. The birds live closely with humans. It is possible that the game is rigged against the virus, of course. For example it might be that the kind of changes that would need to happen are biologically too unfavorable in some way or don't happen for structural reasons. Not impossible or even implausible. We really have no idea because currently we don't understand this virus well enough. But why would a prudent person make that assumption?
Ostriches are birds. And they die of H5N1 infection.
Comments
Didn't the Food and Agriculture Organization of the United Nations issue a press release about a month ago that H5N1 was declining...wrong again!!
Posted by: Tom DVM | July 6, 2007 9:21 AM
Can't control wild or farm mammals either, so...
Heads-in-the-sand, and
officials didn't even make adequate preparations to bury the posteriors.
Posted by: crfullmoon | July 6, 2007 9:57 AM
However H5N1 has changed over the past decade. It went from nan unknown virus to infecting so many species.
The changes seem to be heading in a certain direction no?
More species
higher virulence
persistence.
geographical spread
multiple clades forming
Posted by: Goju | July 6, 2007 10:22 AM
It seems to me that it would be a lot easier if the regulators, repeatedly releasing the confused, mixed messages over the past two years, to start from the other end or the equation.
Once and for all accept the fact that H5N1 is a monster with the very real threat potential to be a one in two thousand year virus. There is now, nine years of evidence to that effect.
Then, cut the bullshit, and start doing what you are paid to do.
Posted by: Tom DVM | July 6, 2007 10:59 AM
There you go again.
FAFing around and Keeping the nightmare alive!
You could well upset Mr.Tony Delamothe, the deputy editor of the British Medical Journal-helping doctors make better decisions-even more than the poor chap already is.
Posted by: birdflunewsflash | July 6, 2007 12:12 PM
In my lifetime,we have had bombs,over population,under population, bird flu and now global bloody warming to fret about.Enough already.All go away.Life will go on without them.
Posted by: mara | July 7, 2007 7:22 AM
mara.
I agree completely. We live with calculated risk...and we always have.
H5N1 may never happen and we all hope it doesn't... but nevertheless, it has the 'real' threat potential to infect 65% of the world's population in 18 months and kill 60% of those affected. That's what makes this one different.
That makes H5N1 and its offspring a 'biological' asteroid and a giant asteroid is the only threat with equivalent potential.
The national security threat is very real...We continue to ignore it and downplay it and disbelieve it at our peril.
We need decisive leadership...so far nobody is willing to put their country ahead of their reputation...in my opinion.
Posted by: Tom DVM | July 7, 2007 9:14 AM
mara.
The perfect analogy:
"The era of procrastination, of half-measures, of soothing and baffling expedients, of delays, is coming to its close. In its place we are entering a period of consequences."
Winston Churchill (1936)
Posted by: Tom DVM | July 7, 2007 10:18 AM
My problem with the "national security" threat issue is simple. We are treating this like its a bad cold if and when HPAI arrives in a neighborhood near you. It isnt. The threat is not the flu itself, but what it could cause. I have written before about the what if the power goes off and I mean even once in the Northeast in a flu pandemic. It would go off because of overload, lack of people to maintain the system, or because of the lack of mined coal or natural gas for those types of plants. .
Sen. Frist tried to get the government to change its way of thinking and for them to stockpile the necessary up to one year. Starting slow, then building up and in the case of food, rotating it to the food banks as it started to expire. Nope. Instead we the world gave 500 milllion bucks to the WHO. They immediately squandered it on bird culls in SE Asia. Sure some culling was needed and some happened. The farmers were compensated. But what did countries do as a rule? Stole it. Vietnamese and Indonesians were building dacha's in Thailand with other countries money. Then the guys that were paid to cull chickens, went right back to growing chickens. So what conclusion other than it wont come or it will come could we derive from what we are seeing now?
If the power goes out in the NE in a blackout scenario due to a single overload then its a one to five day event right now. Think what happens when people die and leave the switches on? There isnt that much surge capability to overcome that if the system fails even today. They couldnt pull it back up circuit by circuit, even by bringing it up sector by sector. The loads are too great. It would take years to get it back even with superhuman efforts and there may not be enough superhumans out there that are alive to do it post flu. Worse, what do the people in the NE do if and when the gas/coal runs out? That stuff doesnt just appear on the utility doorsteps. Coal mining is a young mans job and H5N1 likes young one. What could we do but put old people into mines? Gas comes from holes in the ground and again its a young mans job.
The transmission of coal, gas and electricity after the deal with ENRON at the close of the Clinton administration in California was a big issue for the new adminstration.. It became a front line issue immediately after 9/11. Then the revelations about HPAI with the logical thought processes taken out to the end conclusion really gave everyone an excuse me...shock. We were vulnerable then, we are more vulnerable now. It will take almost 20 years to correct, it will take relaxation of some environmental rules to do it. Most of those relate to transmission lines from places that have excess capabilities to those that have little. Have to do it else, you might not have to wait for the BF to show up with the "national security" issue. It could happen anyway.
Posted by: M. Randolph Kruger | July 7, 2007 11:11 AM
Tom DVM: Your analogy from Winston Churchill gave me chills up the back of the spine.
Three children, under five died within 24 hours of showing the first signs of flu in Australia. A clinical virologist there said the virus was the influenza A(H3) strain.
Posted by: Lea | July 7, 2007 2:24 PM