Flu Guesses

Speaker: Pandemic flu long overdue

By HINA ALAM The Lufkin Daily News

Monday, May 01, 2006

It's not a matter of if. It's a matter of when.

Those were the words of Dennis Perrotta, associate professor of Epidemiology and Biosecurity with the University of Texas School of Public Health, as he addressed the Angelina County Pandemic Influenza Task Force this past week in a workshop session held at Angelina College.

"We are long overdue for pandemic influenza. If history is a predictor of current events — and it usually is — it's going to happen," Perrotta said.

People who know, like scientists and officials at the Center for Disease Control, have been talking about the threat of pandemic influenza for 10 years now, he said.

"Now it's important to know because of the 100 or so (human) deaths of the 200 or so cases (of bird flu),” he said. “That's a lot of people dying. It's a striking number."

Throughout the ages, Perrotta said, influenza started in birds and ended in people. The virus right now is large in birds and has affected only a small number of people, he said. But once it mutates, developing the ability to spread from person to person, and if it still retains the 54 percent kill rate that it is showing now, he said, "that's a global pandemic."

Even if it has a kill rate of even 25 percent, that's a huge impact, he said.

A pandemic strain will cause severe disease in humans because the global human population will not have pre-existing immunity, and it will spread rapidly from human to human. The pandemic will move around the world in six to eight weeks, he said. Twenty to 30 percent will contract influenza during the first wave.

A global outbreak usually happens once every 11 years. "That's not exact science, but that is what history has shown. And it has been 40 years between our last one and now. That's why we're overdue."

Flu pandemics usually come in waves, Perrotta explained. The 1918 pandemic came in three waves over 17 weeks. And the second wave killed young people, he said.

Flu waves last two to 12 weeks. Waves fade and reoccur in one to three weeks. Secondary waves are usually the worst, he said.

Such a pandemic would usually be anticipated to start in the regular flu season, and by the end of it the virus would've changed. "These are ringing bells for the next flu season," he said.

However, the officials and doctors have not tracked flu "as well as we should."

Right now, Perrotta said, avian flu is increasing around the world. The death rate in people infected has been close to 50 percent.

The threat isn't the bird, he said. The threat is human. "More times humans get in touch with birds, more of a chance of human to human contact ... that genetic magic might happen."

And when that does happen, it would not just be a stress, strain and break of the healthcare system, but others too, like the mortuary and public safety system, he said. That is what officials need to be ready for, he said. Businesses, education, religious places and local governments will be affected.

To prepare for such an outbreak, the local government needs to participate and support planning and preparation activities; seek and incorporate citizen/organization input; exercise and adapt plans based on exercise results.

"It's not just an influenza issue," he told the fire department, police and religious leaders in the room. "It's injury, crowd control and other issues. Issues of disposition of dead bodies... religious issues — some religions have specific issues concerning disposition of the dead ... Close major mass gathering for weeks or months... It will be like tornadoes that are spawned from a hurricane — one disaster brings other related ones."

During such an outbreak, Perrotta said, medicines may or may not help. "Healthcare will be overwhelmed." The first vaccine will not be available for four to five months until after the pandemic arrives, and even then, it will be in limited quantity.

After the flu epidemic, there will another epidemic, Perrotta said. "The first epidemic will be illness. The second will be post-traumatic stress disorder." The second would come from losing loved ones and dealing with what has passed.

"A clinical picture of what the next flu outbreak will look like? Hard to say. I don't know if we can prevent this from happening — it's not easy to stop... We need to spend time preparing for it."

There is a bunch of what I consider the "conventional wisdom" in this story, much of which is conjectural. We don't know if a flu pandemic would come in waves. That's what happened in 1918 and we are making a bunch of assumptions based on that. They may not be true. The fact of the matter is that we have so little data about flu that almost everything there is to say about a pandemic influenza is a guess. Keep that in mind while you are deciding how best to prepare. The bare necessity in risk communication is to prepare for the worst, so we need to have an idea of what that is.