Bird Flu Emerging, Experts Worried

An influenza pandemic is coming- public health experts worldwide agree. The main questions remaining are, when it will happen, and how effectively our health care systems will respond to it.

"There's no way to nip this thing in the bud, it will happen. It's just a question of when," said Dr. Trevor Corneil, Clinical Associate Professor at Canada's University of British Columbia and part of the province's avian flu pandemic planning team.

Colloquially known as the 'bird flu', the avian influenza H5N1 strain first raised eyebrows about its potential to develop into a pandemic in January 2004. At that time, a deadly bird epidemic was sweeping across Asia and appearing in pockets of Europe and North America. It devastated poultry farmers with the loss of over 100 million birds either from the disease itself or preventative culling. The alarm bells really started ringing about 18 months ago when the flu "jumped the species barrier," and for the first time and began appearing in humans in Thailand and Vietnam.

Now there is mounting evidence of human-to-human transfer, an essential precondition for a pandemic to emerge. According to a recent World Health Organization (WHO) report, although no human-to-human infection has been confirmed, in Vietnam "the pattern of disease appear[s] to have changed in a manner consistent with this possibility."

There are a variety of reasons why experts are bracing for the worst. One is that "major outbreaks happen every 15-25 years," according to Corneil. "It's now been over 30 years…we're due." The worst outbreak of the 20th century was the 1918-19 Spanish Flu, which killed over 50 million worldwide; it also began as an avian virus.

Another cause for concern is the high fatality rate of those already infected. Of the 100 H5N1 human cases recorded by the WHO in Vietnam, Thailand and Cambodia, 55 have died. "An H5N1 virus with this ability could lead to a global pandemic and many millions of deaths worldwide," warns the WHO report.

In Canada, Corneil anticipates that "20 percent of all Canadians will be infected including one-third of health care providers." This, he concludes, will have massive implications on health services delivery, as well as the economy, with that many people off work.

Australian Health Minister, Tony Abbott, estimates his country could see "2.6 million Australians seeking medical attention, 58,000 needing hospitalization and 13,000 deaths."

The American Center for Disease Control and Prevention predicts that even a "medium-level pandemic" would affect "between 15 percent and 35 percent of the US population" and 2 to 7.4 million would die worldwide.

The potential good news is that the worst might be avoided given advances in global disease surveillance and strategic planning, particularly since SARS. The crucial piece of the containment puzzle, however, will be the effectiveness of communication between global health authorities.

Therein lies the rub. The system breaks down if information isn't shared quickly and completely.
Many people are questioning the reliability of the reporting from within China's borders, in first part due to the Chinese government's initial cover-up of the SARS epidemic.

"There is a question about China," says Corneil, describing the situation there as "a big mystery." Until recently, during the extensive bird flu outbreaks in eight Asian countries, China admitted to only 50 cases which it "successfully…brought under control," according to China's state-controlled media.

On May 21 of this year, the Chinese media confirmed the Qinghai province deaths of 178 wild geese as a result of infection from the H5N1 virus. On May 24, the independent US-based Chinese website Boxun News reported that 121 people in 18 villages had died in Qinghai due to "bird flu infection." Another 1,300 people were reportedly in isolation.

According to the report, "some of the family members of the victims have received warnings. If they keep the secret, the authorities will compensate the family members. Otherwise, they will be punished with the charge of 'deliberately spreading rumors to harm public security'."

The Boxun News website gathers its news from local reporters inside of China, and admits that it cannot verify this report. It is worth noting however that the first reports of SARS in China, published by the ProMED-mail website of the International Society of Infectious Diseases, were taken from Boxun articles.

Two days after the Boxun News story came out, the Chinese state-run media reported health officials as saying that, "No human infection of avian flu or unexplained pneumonia case has been detected in northwest China's Qinghai Province."

"There's an ongoing struggle around what actually has happened [in China]…between the WHO and China. Scientists and doctors [are] saying one thing, and the government [is] saying another. You just don't have the political interference [with respect to] information that is released…in most other countries," says Corneil.

As of yet, there has been no independent corroboration of human infections, or lack thereof, in Qinghai or elsewhere. However, China's past record and the increasing numbers of H5N1 cases in Chinese fowl are making many international experts very nervous. On June 8, H5N1 was reported by ProMED to have emerged in China again, with 1042 geese infected and 460 dead, according to the Veterinary Bureau of the Chinese Ministry of Agriculture.

The WHO highlights the need for the world to take action well before "there is unmistakable evidence that the virus has become sufficiently transmissible among people to allow a pandemic to develop." To head off a worst-case scenario, honest and timely disclosure of human H5N1 infections in China is not only beneficial, but absolutely essential.