Bird Flu: What it Means for You

I've been on the phone now for days chasing down the avian flu story. And I've had email from some of you who are trying to parse the news stories and are wondering what the hell it all means. Let me give you a brief summary suitable for non-scientists.

There both is and is not something new going on. There have been a clutch of confirmed new cases in a cluster in Indonesia. What does this mean? In the past, flu illnesses have been caused by close contact between poultry and people (my colleagues, the reveres, notes cases to the contrary). In Southeast Asia, it is not uncommon for people to literally live with their birds and their children treat them as pets and play with them and usually gather the eggs for the family to eat. There is close contact between the birds, the families and feathers and feces. And then they become dinner, at some point. The disease is killed by thorough cooking of the,er, "dinner animals", but customs are different in different countries and some Southeast Asian cuisines feature dishes made with raw poultry blood. Until the past week, disease trackers have been able to confirm by testing that each case was caused by a sick bird, who was either dinner or in close contact with the sick person. In the last few months, we started discovering cases among the family members of those who took care of the sick person. The disease still stayed close to the birds, those who tend them and immediate family.

Since the first of the year, we've been seeing more cases where the sick person had no contact with the chicken but have had close contact with the person who got sick from the chicken. In the last couple of weeks, we've begun to see new cases which didn't live with the first two cases, which were typically immediate family members. It's still happening among family members, but not ones who live together and are caregivers for the others. In other words, these are still people who are in extended family members, but don't live in the intimate setting of the immediate family.

What does this mean? Pandemics happen when a virus or a bacteria develops a couple of characteristics: it develops the genetic ability to make humans sick (most human infectious disease is transmitted to us from animals through genetic changes) and it becomes easy to transmit between people. In the last century, we had three big flu pandemics (and a couple of "echo" local epidemics) and we know from history that three or four of these things happen every century. The last was in 1968. There was a huge one in 1918 that killed literally millions of people around the world, estimates range from 25-100 million world wide. You can read about it in a superb book about this medical disaster, The Great Influenza: the epic story of the deadliest plague in history. The title is not hype. This historical event was so horrifying to those who lived through it that they were unable to speak of it and "the great forgetting" began.

The flu virus is the great mocker of what we like to think of as our progress in medical science. In about 1997, a novel flu virus, tagged H5N1 for its genetic markers, emerged in Asia. It was horribly deadly to birds and to the few humans who contracted it from poultry. It caught my attention that year. I was aware of the cycles of human flu infections and knew that it was about time for a new bug to emerge which could infect humans: all human flubugs were first birdbugs. I started following this one back then and first started writing about it here when human cases started make some news in the main-stream media (as opposed to the scientific press) in 2004 and began writing about it here then. This is not the flu virus which circulates in the winter months every year for which we sometimes remember to get a flu vaccine shot. I'm trying to keep the scientific vocabulary out of this piece, but here those words of difference are poetic in their ability to invoke horror: highly pathogenic. What that means is that this virus has demonstrated an ability to cause grave illness and death which literally scares its researchers to take dramatic action to care for their families. There is no vaccine and it is unlikely that there will be one if this virus becomes a human disease. Right now, it kills more than half of the people who get it. In 1918-1919, the Great Influenza killed someplace between 2.5 and 5% of the people who got it and most researchers think that 30-40% of the planet was infected (not all became sick but most did, when novel virus appears, we have no natural immunity.) H5N1 makes 1918 look like a practice swing.

H5N1 influenza is a novel virus of extraordinary lethality. Should it evolve to the point where it becomes easily passed between humans, the level of damage it could do to us and our society is nearly unimaginable. What's the likelihood of this happening? Frankly, we don't know. There is no data. What should you do when it is impossible to calculate the risk, but the risk of what happens if you get it wrong is off the charts? Prepare for the worst case, hope for the best.

Dr. Rob Webster, the dean of flu researchers in the US, has stockpiled three months of food, water and necessary medications for his family. Rob is not a catastrophist or a survivalist, he's a sober-sided scientist who says that this is the scariest virus he's ever seen. In this country and most of the industrialized world, our food, water, pharmacies and other vital infrastructure have gone to "just in time" delivery systems which depend on trucking and shipping. If you think your neighborhood grocery has a big back room full of supplies to restock the shelves, guess again. They and Walmart and all of the other retailers you rely on to meet your daily needs are going to be crippled if 30-40% of their employees and the truckers who supply them are sick or home taking care of sick family members, or simply afraid to go out and maybe get infected. This flu causes grave illness, not a couple of days of aches and a sore throat. The people who get it are sick for weeks. And the rate of death is simply off the charts. The virus is not yet "efficient" at being passed between humans. Will that change? We don't know. There is a probability which is greater than zero which says it never happens. There is also the known ability of all flu virus to demonstrate genetic alteration which it allows it to find more hosts, places where it can replicate and spread, and the flu has loved doing that in people for eons.

Stockpiling non-perishable foods and extra water for a period of 3-6 weeks is not unreasonable, given how long it will take the disease to run and ordinary commerce to resume after such event. Don't expect power outages to be repaired in their normal couple of hours if line employees are on sick call. Don't expect to be able to get to your gas station or ATM. If the power is out, you won't be pumping gas or picking up cash.

In Florida and the other Gulf states, people are told to be prepared for 72 hours of being on our own during hurricane season. Imagine that everything is disrupted for three weeks instead of three days; it happened here after Hurricane Isabel in 2003. Imagine that lasts for months.

This is not a thought exercise. This is a real possibility, one which became closer with the science news out of Indonesia. You can decide how you want to respond.