Avian Flu: How Scared Should We Be?

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•WHAT MAKES THIS PARTICULAR AVIAN FLU SO DEADLY?

For reasons that aren't entirely clear, the current H5N1 flu, unlike common flu, strikes deep within a patient's lungs, making it harder to spread to someone else and unusually lethal. Dr. Nguyen Hong Ha of Hanoi's Bach Mai Hospital has probably treated more cases than anyone else. Two-thirds of the deaths from bird flu since 2003 have occurred in Vietnam. Ha has watched the virus ravage the lungs of healthy young patients in a matter of days. He says the key to treatment is applying just the right amount of breathing assistance. Too much, and an H5N1 patient's weakened lungs could burst. But, he says, survival ultimately comes down to "the patient's immune system and the will to fight."

Antiviral medications like oseltamivir (Tamiflu) have shown promise in tests but must be taken within 48 hours of the first symptoms' appearance--requiring a very swift diagnosis. More in-depth study is needed to assess how well those drugs would work against a pandemic--something that's tough to do with so few patients and viral samples.

In the end, the best course of action is not to treat this sort of flu but to prevent it. Preliminary results, released in August, of an experimental vaccine against bird flu suggest that a high-dose vaccine given in two shots a month apart would yield the best response. "What is sobering is how much was required, which puts an added pressure on vaccine production," says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

•HOW CLOSE ARE WE TO A PANDEMIC?

There have been 10 pandemics in the past 300 years. The most recent one was the relatively mild Hong Kong flu of 1968. But you can't say that we're overdue because biology is not that simple. Nor is it even certain that H5N1 is the strain that will eventually cause the next pandemic.

There are troubling signs, however, that H5N1 is on the move. The virus killed thousands of wild geese in China this past spring and popped up among migratory birds in parts of Siberia this summer. There was a report in May about a handful of infected pigs in western Java. Even more worrisome, Indonesian health authorities said last week that a number of chickens on household farms in Jakarta had been testing positive for H5N1 without showing signs of illness. If confirmed, that development could severely complicate efforts to track and control bird flu in poultry. Without dead chickens, you can't tell where the disease is moving.

But so far, tests on samples taken from two of the most recent human victims of bird flu show no cause for immediate alarm. "There are no obvious changes in the virus that we tested," says Dr. Guan Yi, an avian-flu expert at the University of Hong Kong who has helped sound the pandemic alarm. For now, he says, there's "nothing new. Nothing to worry about." The viral genes are still the same avian-flu genes that haven't figured out how to spread easily from one person to another.

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