Have you wondered what the big commotion is regarding bird flu? Are you still confused about how avian influenza came to be and why epidemiologists are so afraid of it? Do you wonder why I have gone on numerous tirades about how the virulent H5N1 strain did not originate in wild birds, but rather, is a product of human creation? Throughout the entire book, Doctor Michael Greger examines influenza viruses and what makes them into such killers by meticulously weaving together historical, medical, ecological, agricultural, viral, and economic factors that contributed to the “hatching” of this disease threat in his book, Bird Flu: A Virus of Our Own Hatching (NYC: Lantern Books; 2006).
In part one, “Storm Gathering”, the author discusses the 1918 pandemic, also known as Spanish Flu, revealing what is known of its humble beginnings as a relatively mild flu bug to its emergence as a powerful world-wide pandemic. Then the author turns his attention to the current strain of avian influenza, H5N1, and discusses how intensive production of domestic poultry for their meat and eggs have allowed this strain of influenza to become a killer and how it is changing from a birds-only virus into a new strain that can infect humans — albeit inefficiently so far. One particularly lethal version of H5N1, known as the Z+ H5N1 strain, has become very efficient at killing a variety of mammals, including humans — similar to the SARS virus. Unfortunately, we do not have an effective way to treat such a virus, if it ever becomes better at transmitting itself from human to human. Antibiotics only kill bacteria and thus do not touch virsues, it takes a nearly full year to manufacture a vaccine, and there is only one drug that is effective at treating an infection, the anti-viral, tamiflu. Finally, the author gives a brief overview as to why this form of avian influenza could be more disastrous than the 1918 flu pandemic.
Part two, “When Animal viruses Attack” is the largest and meatiest section of the book, by far (no pun intended). This section focuses on a variety of animal microbes that have emerged in the human population, including HIV, SARS and ebola, and it explores the epidemiological similarities and differences between these emerging diseases and avian influenza.
Then the author describes how we have done this to ourselves by relying on intensive animal farming methods to produce cheap meat and eggs. These methods include extremes in overcrowding, inbreeding and accumulated filth, the wide-spread use of antibiotics in animal feeds and the practice of feeding processed animals and animal waste to other farm animals. After these microbes become established in domestic animals, close contact with people — as seen on many farming operations in Southeast Asia — allows them to jump the species barrier into humans. Then overcrowding and poor hygiene in people leads to efficient transmission and increased lethality of viruses within the human population, as witnessed in the 1918 flu pandemic among soldiers during WWI. That particular influenza strain, H1N1, jumped from domestic animals into soldiers and then was transmitted throughout urban civilians and people living in small towns, killing on average half of those that it infected. And some small towns were completely devastated.
Part three, “Pandemic Preparedness” discusses the strategies for containing influenzas with pandemic potential before they can escape into the human population and how it is crucial for such a reaction to be very quick if it is to be effective at all.
Part four, “Surviving the Pandemic”, describes a basic personal “survival kit.” The author recommends that everyone should try to accumulate a personal stockpile of Tamiflu because, if the author is correct, the United States government has been embarassingly slow in this effort on behalf of its citizenry. Additionally, as mundane as it sounds, the author also recommends washing your hands frequently as well as practicing avoidance techniques such as “social distancing” — avoiding large gatherings of people if the flu strikes. Additionally, he advises us to prepare at home by saving several weeks’ worth of nonperishable food items and water in the event that one must ride things out.
The last part, “Preventing Future Pandemics”, maintains that the emergence of Ebola-like superstrains of influenza can be prevented. The author reviews the totality of variables that accelerate ongoing genetic mutations within H5N1. He takes us step by step through the process whereby a harmless waterborne duck virus becomes a deadly airborne chicken killer that now threatens all of humanity. As a result, we are facing a deadly killer that was caused by the excesses of large commercialized poultry farms. However, one positive aspect at the present time is that H5N1 does not easily pass from one human to another.
What can society do about this gathering threat? First, we must correct how chickens and other domestic animals are raised. The huge factory farms where they are now raised commercially are seething with a variety avian influenza strains and other diseases. “To reduce the emergence of viruses like H5N1, humanity must shift toward raising poultry in smaller flocks, under less stressful, less crowded, and more hygienic conditions, with outdoor access, [and] no use of human antivirals,” Greger advises his readers. Next, we must support the development of vaccines against the virus. However, he recognizes that this will be difficult because we cannot know which form the pandemic virus will take and also because it takes so long to develop a new vaccine.
With eloquence and precision, the author cites data from hundreds of scientific and lay sources within multiple disciplines, overcoming the compartmentalization that characterizes most other approaches, to analyzing the origins and characteristics of the virus itself, without diluting the rigor of scientific analysis.
No dount about it; this is a sobering book. If the author’s analysis is correct, we should be taking action now. Certainly, communities and health care organizations ought to be planning for what could happen if a pandemic actually occurs. If nearly half of all workers become ill, there will be a breakdown in services everywhere, and there has to be some planning for such an eventuality. And last but not least, we must get used to paying more for chicken and eggs.
Michael Greger, MD is the Director of Public Health and Animal Agriculture at the Humane Society of the United States. He is a recognized lecturer on public health issues, presenting lectures at the COnference on World Affairs, the National Institutes of Health, and the Bird Flu Summit among other symposia and institutions. Dr. Greger is a graduate of the Cornell University School of Agriculture and Tufts University School of Medicine. He also wrote Carbophobia.