Avian Flu: How Scared Should We Be?

Sunday, Oct. 09, 2005 By CHRISTINE GORMAN
VACCINATED: Veterinary officers inoculate a flock of ducks against bird flu in Vietnam
HOANG DINH NAM / AFP/ GETTY IMAGES
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But vaccines aren't the whole solution. Should a pandemic take hold, demand would soar for surgical masks, hospital beds, mechanical ventilators--which help people breathe when their lungs are fighting an overwhelming infection--and other items. "We have only 105,000 ventilators right now in America, and 95,000 are being used," says Tommy Thompson, a former HHS Secretary who startled a lot of people last December when he said pandemic flu was one of the two things that kept him awake at night (the other was the safety of the food supply).

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•WHO'S IN CHARGE?

That's still being worked out. As things stand, HHS would be in charge of the federal medical response. The Department of Homeland Security would handle the emergency response, as it does after a hurricane. But most of the authority sits with the states, which are free to call on the Centers for Disease Control and Prevention.

States are in charge of public health, with help from local officials. That is great news if you live in a place like Seattle, Los Angeles or New York City--places that health experts cite as relatively well prepared. Others may want to contact their officials and ask what they are doing.

•WOULD A QUARANTINE MAKE A DIFFERENCE?

Despite what the President said earlier last week, a quarantine would probably not be an effective solution for a bird flu that has become pandemic. It is hard to tell who is sick because humans are contagious before they show symptoms. And communities today are much too interdependent to shut down their borders for months on end. (Quarantines worked to control the SARS epidemic because SARS is much less contagious than flu and has a longer incubation period.) That doesn't mean we won't have quarantines. "Politicians will be under a lot of pressure to demonstrate that they are doing something," says Monica Schoch-Spana, a medical anthropologist at the Center for Biosecurity at the University of Pittsburgh.

Far more realistic than a quarantine, health experts say, would be isolation and perhaps some kinds of movement restriction. Sick people, either at home or in hospitals, would be kept apart from healthy people. Caregivers would need to use masks, if there were enough of them, and other barriers to prevent infection. For the rest of the population, large gatherings might be discouraged. Schools, malls, churches and sports events might temporarily shut down--although even that would be of questionable effectiveness.

That is all scary stuff--and it may be years away--but a worldwide epidemic is brewing. No one can tell if it will be a Category 1 or a Category 5 storm or when it will hit. Katrina taught us you can survive the initial catastrophe and perish in the aftermath. "We are seeing the unfolding of a pandemic in slow motion," Dr. Klaus Stohr of WHO told a group of business leaders at Deutsche Bank in New York City last month. "We can reduce the damage, but we cannot avoid it."

 

TAKING FLIGHT

Since 1997, the H5N1 strain of the avian-flu virus has traveled steadily west across Asia. The current outbreak began in December 2003, infecting humans in Cambodia, Thailand, Vietnam and Indonesia. Although Southeast Asia has borne the brunt of the disease, scientists fear that infected migratory birds will spread it further, resulting in a global pandemic.