The Next Hurrah: Flu Stories

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February 24, 2006

Flu Stories

by DemFromCT

Combining two favorite topics of mine (bird flu and polling), here's a bird flu poll, courtesy of Harvard School of Public Health. Some of the interesting findings:

More than half of Americans (57%) report that they are concerned about the potential spread of bird flu in the United States (Figures available here in .ppt). However, only 15% are very concerned at the moment. A higher proportion of African Americans report that they are concerned about this than whites (70% versus 54%). Similarly, the majority of Americans are not currently concerned that they or a family member will get avian flu within the next twelve months; only one in five (21%) people are worried about this possibility. Six in ten people are concerned about a pandemic outbreak of avian flu, that is, an outbreak in many countries (62%), but only 20% are very concerned. In addition, the American public does not believe avian flu will ultimately spread widely among wild birds (only 28% think so), poultry (24%), or humans in the United States (14%) in the next 12 months.

If the U.S. were to experience human cases of the avian flu virus currently circulating in Asia, there would be significant public reaction. If such cases were to occur in their state, most people said that they would reduce or avoid travel (75%), avoid public events (71%), try to get a prescription for Tamiflu or other antiviral drugs (68%), and stay at home and keep their children at home while the outbreak lasted (68%).

"If the public were to respond this way to human cases in their state, it would likely slow the spread of the disease, but it would also have major impact on the state's economy and health care system," said Robert J. Blendon, Professor of Health Policy and Political Analysis at HSPH. "Because of this, it is important to prepare for a prompt and effective public health response."

Buried within the survey is the observation that 80% of respondents' info came from television, 11% from non-governmental websites (like Flu Wiki) and only 5% from govt. sites (q. 8). And that the CDC is far more trusted (by 73%) than DHS (by 32%) of poll responders (q. 40).

Meanwhile, H5N1 is becoming endemic in Europe. This means that the poultry may be exposed again and again to the virus, as has already happened in Hong Kong. The longer term approach may be a better vaccine for poultry and humans; short term, culling and other methods must be used. But senior flu researcher Robert Webster in this paper warns against killing migratory birds:

Although culling domestic poultry to contain the spread of highly pathogenic H5N1 virus is considered an acceptable agricultural practice, culling migratory birds is not acceptable to any international authority (Food and Agriculture Organization of the United Nations [FAO], the World Organization for Animal Health [OIE], the World Health Organization [WHO]). The idea of culling migratory birds must be strongly discouraged, for it could have unknown ecologic consequences.

Instead, since highly pathogenic H5N1 has been demonstrated in migratory birds, the poultry industries of the world must adapt measures such as increased biosecurity (Figure 1), the use of vaccines, or both.

And Webster also makes a strong case for flu prep:

We cannot afford simply to hope that human-to-human spread of H5N1 will not happen and that, if it does, the pathogenicity of the virus will attenuate. Notably, the precursor of the severe acute respiratory syndrome (SARS)-associated coronavirus (31) repeatedly crossed species barriers, probably for many years, before it finally acquired the capacity for human-to-human transmission, and its pathogenicity to humans was not attenuated. We cannot wait and allow nature to take its course. SARS was interrupted by early case detection and isolation, but influenza is transmissible early in the course of the disease and cannot be controlled by similar means. Just 1 year before the catastrophic tsunami of December 2004, Asian leaders rejected a proposed tsunami warning system for the Indian Ocean because it was too expensive and the risk was too remote. This mistake must not be repeated in relation to an H5N1 avian influenza pandemic. We must use this window of opportunity to prepare and to begin prepandemic implementation of prevention and control measures. 1

Waiting until the virus hits is way too late to prepare. The suggestion is for small business and individuals alike:

"Take incremental steps and build on that."

That's sound advice that will serve you in an earthquake, ice storm, or flu pandemic. And with luck, your preparation will never be needed.

How Academic Flap Hurt World Effort On Chinese Bird Flu

And if you think DC or primary politics are vicious, stay out of the way of academic politics (WSJ, search for Nicholas Zamiska):

China's efforts to maintain control over samples of avian flu taken on its soil, as well as the research done on them, have put it at odds with international health officials trying to defeat the disease.

The standoff pits a high-ranking veterinarian in China's Ministry of Agriculture named Jia Youling against international health authorities leading the fight against bird flu. Their conflict surfaced after wild birds began dying by the thousands last spring in a remote region of western China. At the ministry's headquarters in Beijing, officials from the World Health Organization and the United Nations' Food and Agriculture Organization asked Dr. Jia to share with them the samples of bird flu that scientists under his ministry had collected from the birds.

He didn't provide them. Instead, Dr. Jia -- a professorial-looking 58-year-old who had risen steadily through the ministry's ranks since he joined it in 1979 -- began to talk about a recent research paper he had noticed on avian flu. According to Julie Hall, the WHO's top communicable-disease expert in Beijing and a participant at the meeting, he had a complaint: Months earlier, a team led by American scientists published a paper in an academic journal using China's samples, but without crediting or consulting their Chinese counterparts. The occasion, Dr. Hall says, "was used to express their deeper concern about ensuring that Chinese scientists were duly recognized." Dr. Jia declined to comment, saying, "I don't want to mention those things because they are all in the past."

All in the past, but samples have been tough to get from the Chinese ever since. Note that the lab in question is also Dr. Webster's, who ably defends himself later in the article (the man is in the middle of everything flu). But just as with HIV and the French vs the US, international prestige trumps saving lives, apparently. Was it Stephen Colbert who said about the Olympics, "It's not about winning... it's about rubbing it in"?

cross-posted at The Daily Kos.

February 24, 2006 at 07:29 in Contributor--DemFromCT, Health Policy, Polls | Permalink