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SnakebyteXX
05-26-2005, 09:26 AM
Flu pandemic looms, experts warn world

Many millions could die if Southeast Asian bird virus mutates to easily transmitted form

Sabin Russell, Chronicle Medical Writer

Thursday, May 26, 2005

A lineup of leading infectious disease experts warned Wednesday that the world is unprepared for the health and economic consequences of an outbreak of pandemic influenza that could spring from a lethal strain of bird flu now ravaging poultry flocks in Southeast Asia.

In commentaries published in the British science journal Nature, doctors used some of the strongest language yet to suggest that the bird flu virus known as H5N1 could mutate into a form easily transmitted among people, creating a strain capable of killing millions.

"This virus has the potential to trigger the next pandemic, which, judging from history, is well overdue,'' wrote Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in Bethesda, Md. "Clearly, there is much to be accomplished, and time is of the essence.''

Flu pandemics are global outbreaks of virulent influenza caused by a viral strain so different from those of prior years that the human population has no natural resistance to it.

The 1918 Spanish flu was such a pandemic, and it killed an estimated 20 million to 100 million people around the globe. The H5N1 virus has worried flu experts since 1997, when it first appeared in the Hong Kong chicken markets as a lethal virus dubbed bird Ebola. After it infected 18 people, killing six of them, Chinese authorities ordered the slaughter of 1.5 million chickens, abruptly stopping the outbreak.

In December 2003, H5N1 re-emerged in Southeast Asia and has killed millions of birds and 53 people. Efforts to contain the virus by culling birds have failed. The virus is being spread by wild ducks, which carry the virus but don't die of it.

In an interview, Fauci said the purpose of the Nature commentaries is to draw more world attention to the problem. "The ingredients (for a pandemic) are starting to accumulate,'' he said. "This is a situation that might go away this season, but it's not going away forever.''

Fauci said that federal spending on influenza preparedness has increased to $419 million from $40 million over the past five years but concedes he is not satisfied with the United States' current level of readiness.

For example, even though an experimental H5N1 vaccine is being tested, the system for manufacturing it -- the same system that produces millions of ordinary flu shots -- is failure-prone. "Capacity needs to be built up,'' Fauci said.

Similarly, the federal government has stockpiled only enough Tamiflu, an antiviral drug that has shown promise against bird flu, to treat 2.3 million Americans. That is less than 1 percent of the population. Great Britain has ordered enough to cover 25 percent of its people.

"We're definitely going to increase the stockpile. That's for sure,'' Fauci said, calling it a top priority of the Department of Health and Human Services. Just how much drug the government wants, he wouldn't say.

Swiss pharmaceuticals maker Roche Inc. produces the entire world supply of the drug at a single European plant. Federal authorities have been negotiating with Roche to build a Tamiflu factory in the United States.

In another Nature commentary, famed virologist Dr. David Ho of New York's Aaron Diamond AIDS Research Center argued that China needs to confront the emerging threat of bird flu openly. "The world, China included, must respond as if the next pandemic is imminent,'' he wrote. Ho estimated that up to 207, 000 Americans could die in it. "What will the death toll be in China?" he asked.

Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, warned in his Nature paper of the economic consequences of a major pandemic.

"The world today is much more vulnerable to the collapse of trade than it was in 1918,'' he wrote. He dubbed the potential economic fallout "pandemic shock.''

Osterholm wrote that an H5N1 pandemic strain could rival the devastation of the 1918 pandemic. Industrialized nations reliant on "just in time" delivery of health care goods do not have enough medical supplies to care for the sick. "Nor are there detailed plans on how to handle the dead bodies whose numbers will soon outstrip our ability to process them,'' he wrote.

Osterholm said the world's leading economic powers need to confront the problem directly at the forthcoming G8 meeting in Scotland. He calculates that, with the world population swelled to 6.5 billion,a flu strain as lethal as the one in 1918 could kill 180 million to 360 million people worldwide.

Also an expert in terrorism, Osterholm observed that there were ample warning signs that an event such as the Sept. 11, 2001, attacks was possible. Those warnings were fully recognized only after the fact.

"People like myself are often seen as scaremongers," he said, "but I'm afraid we are doing this all over again.''

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