The Tip of the Iceberg


Over the past week, four children in Turkey have died, officially, of Avian Flu. Depending on whom you believe, between 20 and 200 other people in Turkey have been infected. In the far east, in Indonesia, 2 more children have died. Officially, the death toll is around 80 worldwide. Roughly half of those confirmed to have been infected, have died. This, if it holds up, is a staggering mortality rate.

There are reports, unconfirmed, of scores more that have succumbed, particularly in China, where tests were not performed and the bodies were burned immediately. The Chinese government has historically not been forthcoming when dealing with health threats or any news that might cast China in a poor light.

As far as we know, all of these victims have had direct contact with poultry, or birds, and contracted the disease directly from this B2H contact. The WHO has admitted, tho, that they have not fully investigated all of these deaths, and that it is possible some of these were Human to Human (H2H) transmission. If so, the virus is not easily passed between humans, else we’d have seen many more cases.

But we do know the virus has mutated over the past few months, and that these mutations make it easier for humans to acquire the virus. Additional mutations are inevitable. Each time the virus takes up residence in a new host, it has the opportunity to mutate. If someone has a standard flu, and is co-infected with the Avian (H5N1) flu, the possibility exists that a hybrid will be created. One that retains the lethality of the H5N1 and has the contagiousness of H3N2, or seasonal flu.

And that is the WHO’s worst nightmare.

So far, that hasn’t happened. In fact, it may never happen.

Imagine you have a deck of cards, randomly shuffled. You deal the first 5 cards off the top of the deck. What are the odds of dealing a Royal Flush? About 640,000 to 1. Probably about as likely as the H5N1 mutating into a highly lethal H2H flu.

It is a low probability event.

But deal 640,000 hands, and the odds are, at least once a Royal Flush will be dealt.

As of today, hundreds, perhaps thousands, of flu `hands’ have been dealt. Each day that number increases. At some point, the odds say that the right combination will come up. At least that’s the worry.

Of course, there are many combinations besides a Royal Flush that could prove disastrous. Perhaps 4 of a kind produces a virulent, but slightly less deadly flu. The odds of dealing 4 of a kind, btw, are only a little over 4000 to 1.


It is assumed that millions of wild birds carry the H5N1 `bird flu’ virus. Sometimes the birds die, but often they simply carry and spread the disease. Each day that passes, more birds contract the virus, and spread it as they do their seasonal migrations. So far, infected birds have been found in Asia, Russia, and now Eastern Europe. This spring, the infection is expected to reach Europe and Africa. It could also reach Canada and the United States later this year.

The threat is two-fold. Direct infection from birds, or a H2H mutation. Either way, the disease is likely to spread. The only question is, how fast will it spread? Complicating matters, nearly all mammals can contract this flu. Dogs, cats, pigs, horses . . . .

It is conceivable that your cat, valiant hunter of small birds, might kill an infected bird and bring the virus into your home. Or you dog may find a dead bird and become infected. Not a pleasant thought.

In Asia, and now in Turkey, they are culling poultry in an attempt to eradicate the disease. This may help, but does nothing about the birds in the wild. To try to kill all of the infected birds in the world is impossible.

What then, can be done?

The primary threat is a mutation. If this happens, human spread will be rapid. Our best hope is that it is detected early and quarantine can be established so it can be contained. With much of the infected bird population residing in 3rd world countries, often with repressive governments who are either unable or unwilling to address the problem, the risks of a mutation going undiscovered for days or even weeks is enormous. That would be enough time for a pandemic to get started.

This week, at an Avian Flu conference, the nations of the world have pledged nearly 2 Billion dollars to 3rd world nations to help fight this disease. Whether this is enough, and if it will be spent wisely, is something only time will tell.

So we are left with a great unknown. There is a potentially devastating disease simmering quietly in the wild. It must mutate further to become an effective H2H disease, but the potential is certainly there.

Scientists are divided as to whether this will happen. A few believe it is unlikely. Many believe it is inevitable. The head of the World Health Organization (WHO) says the odds of a pandemic are `great’.

For now, all we can do is watch and wait. And yes, prepare.

There are dozens of unanswered questions. As I blog, I will try to address as many of these as possible, although answers may be difficult to discern. The social, economic, and medical implications of a pandemic are simply enormous.