History on the side of bird flu
Mutating virus likely to become pandemic if past is indication
http://www.chronicle-tribune.com/apps/pbcs.dll/article?AID=/20060423/NEWS01/604230343/1002
BY DAVID PENTICUFF
penticuff@marion.gannett.com
It would be a marker in time.
There would be the way life was before and the way it became afterward. Such times - the Civil War, the Great Depression, World War I and II, Sept. 11, 2001 - make up the longer chapters in history books and leave few in society untouched by the experience.
"I have absolutely no doubt. I am 100 percent positive that we will have a pandemic," said Dr. Gregory Poland, a physician at the Mayo Clinic, an international expert in vaccinology and biodefense and an adviser to President George W. Bush and Congress about such matters. "What I can't say is when. Will it be avian flu? It is most worrisome."
The H5N1 virus, more commonly known as bird flu, makes persistent but low-grade headlines in the United States as it continues to mutate, Poland said, toward a form that would make it easily transmittable from human to human. Meanwhile, people at the county, state and federal level are preparing for what they think would be worst.
Congressional Budget Office research found that a severe pandemic, such as what is threatened by human-to-human transmission of avian flu, would kill 2 million Americans. Thirty percent of workers in the United States would fall so ill they would miss three weeks or more of work. Such an event could cripple police and fire departments, power plants, schools and cities' basic infrastructure.
"Be afraid, but don't panic," said Maxine Hughs, director of Taylor University's Hakkonsen Health Center.
She has been studying the avian flu virus for months, and is part of a team of officials in Grant County helping to plan for the worst. She also understands that skeptics are plentiful.
On the surface, not taking pandemic warnings too seriously might seem like common sense.
The current generation lived through the SARS scare, a respiratory illness that killed 774 people around the world before it was contained in 2003. Some can remember the would-be pandemic of swine flu that never materialized in the 1970s, and many have been jaded by scientific prophets of doom, who created a whole industry at the turn of the century with fears of the technological effects of Y2K.
"This is not like that," Hughs said. "It is not like that at all."
The avian flu's move toward a pandemic is unfolding in a fearfully scripted way, Hughs and Poland said, as it quickly spreads from animal to animal, continent to continent and nation to nation.
In November 2005, the virus had been confirmed in birds in 16 countries and was known to have infected 122 people, killing half of them. Four months later, it has spread to 37 nations on three continents and has infected 175 people - 96 of whom have died.
"With SARS, nothing happened, although we were not prepared for it," Poland said.
That viral disease was contained through quarantines and isolation of its victims and those who had been exposed. It was, Poland said, evidence for what being proactive can do to stop an outbreak.
But the H5N1 virus is a different sort of threat, he said.
So far, there has been no sustained human-to-human transmission, but it appears that might be just a function of time.
First of all, the avian flu virus is remarkably resilient. It first appeared in Hong Kong in 1997 and promptly went away, only to survive and resurface six years later. The virus continues to mutate in ways that take it down a path leading to common human transmission, Poland said.
And history would seem to be on the side of the virus. The last devastating influenza outbreak occurred in 1918, and it is that model that CDC is using to predict what could happen in coming weeks, months or years. The 1918 viral strain, also known as the Spanish flu, also originated in birds, which carried it everywhere. Through mutation, the virus leaped directly from the winged creatures to humans. It killed 40 million people worldwide, including 10,000 Hoosiers.
In 1918, the pandemic was first detected Sept. 20 in Evansville. It was in Indianapolis by Sept. 25, and had spread through the state by Oct. 11.
The Indiana Board of Health, which still carries much power in the case of a health emergency, banned all public gatherings in the state. Churches were opened for prayer but not large services. Public funerals were banned. Schools were closed. Masks covering the nose and mouth were required in stores and streetcars, said Mike Leavitt, U.S. Secretary of Health and Human Services.
Leavitt spoke to officials in during a pandemic flu summit in Indianapolis late last month.
"The victims included a Mrs. Estil Graffis and her husband who lived in Fulton County. Estil died on a Wednesday. Her husband followed the next Monday. Within a week, influenza had made orphans of their three children." Leavitt said. "Tragic stories like that of the Graffises were not uncommon across the state."
And now, people are more mobile than they were in 1918.
"It is going to be all at once - worldwide - when it hits," Hughs said of the avian flu.
In an article published March 30 in The New England Journal of Medicine, Poland said vaccines are likely to be the single most important public health tool for bringing a pandemic under control. A vaccine for avian flu appears to be on the road to development, but it is a race against time.
Who distributes the vaccine and who keeps the supply will be key.
"It won't be the corner drug store," Poland said.
It will be people like Cathy Glickfield, Grant County's public health coordinator.
Glickfield is working now on a plan in conjunction with Marion General Hospital, universities and the county Emergency Management Agency, on how to respond in the case of a pandemic.
Right now, she said, Tamiflu, a medicine used to treat flu infections, is being stockpiled nationally in advance of a potential outbreak. The county health department, in conjunction with local universities, would set up clinics. The medicines must be taken within 48 hours of when symptoms appear in order to have any effect.
Marion General Hospital already has drawn up an internal plan on how to handle a pandemic and is now working on a communitywide plan. Dick Martin, manager of protective services at MGH, said the hospital has developed plans for keeping infectious patients separated from other patients. It also has plans to move the sick to other institutions around the community, including Indiana Wesleyan University, to accommodate an expected surge in patients.
"We will do what has to be done," said Bruce Bender, EMA director. "We will manage somehow."
He said he has heard Indiana is a low-risk state, but the county is making plans for a pandemic and the problems that could arise if many people fall ill, including emergency personnel.
"If I have to man a (fire truck), I will," Bender said.
The agencies involved in planning will get together Wednesday to discuss the scheduling of a town hall meeting on the potential for a pandemic and local response.
"They are telling the states they are on their own" if a pandemic occurs, Hughs said of health officials at the federal level.
In the meantime, Poland said, people should cough into their elbow instead of their hands to cut down on the transmission of illness, wash their hands frequently and do all thing things that most people were taught as good hygiene. Also, getting in better overall physical condition, exercising and not smoking can help survivability in case the bird flu - or any other infectious disease - comes to town.
Getting a seasonal flu shot is very important with the threat of a pandemic flu virus, he said, because a person who would contract the seasonal flu along with the avian flu could become a factory to create a third and even more potent flu virus.
"Biologically," Poland said, "that's how things work."
Pandemics are natural occurrences, like earthquakes and hurricanes.
In the late 1950s, the Asian flu killed about 70,000 Americans. In 1968, the Hong Kong flu killed less than 40,000 Americans. Seasonal flu, the illness Americans try to inoculate against with flu shots every fall, kills about 40,000 in each year.
Vaccinations and better treatment for pneumonia and other health problems associated with the flu probably account for why the last two pandemics were not bigger killers in the United States, especially compared to the 1918 outbreak, Poland said.
"This does not transfer easily from human to human now," he said. "When it does, time will be marked."
Originally published April 23, 2006
My reccomendations: prep how you know best... 
That's why I try to stay to posting harder news. Numbers of suspected and confirmed cases... firm percentages of sales figures, etc. My economic driver opinion might be off, but it's what I've developed watching patterns. And last fall the CFR gave a 'heads up' with where the AF focus would go...
) The rest of your opinions are educated and well thought out. Both on BF and Iran. I confess that there are days when I cannot read every word of every article. Often, the opinions of TB members that wrap-around the articles are of more interest to me, including yours. Keep 'em coming. And thanks. (I'll reciprocate during hurricane season. 
)