Bird flu, Wherefore Art Thou?

#242


If you read the newspapers, you may be under the mistaken impression that the upcoming pandemic has been canceled due to lack of interest. Between the announcements of miracle vaccines on the horizon, pandemic plans in place, and a recent dearth of human cases, it is all too easy to become lulled into complacency.


I understand the appeal, and frankly, I’d much rather be looking for my next sailboat and dreaming of my long planned voyage to the South Pacific. The potential of a pandemic has put a huge crimp in my well-laid plans, and I’d just as soon move on to more pleasant matters.


Sadly, this lull in the action is likely to be short-lived. The virus is still out there, still mutating, and the threat has not gone away.


The question remains: What happened to the staccato bursts of H5N1 news we’ve grown so used to over the past year or so? Why, suddenly, are we hearing almost nothing?


It is axiomatic that we can’t know what we don’t know. And so we are reduced to making guesses. There are a number of possible explanations for the recent downturn in news items, and pending further information, all we can do is pick one we fancy.


The most appealing option is that the H5N1 virus has simply fizzled out. It has been, after all, 3 weeks since the last human death was reported, and except for South Korea, reports of poultry and bird infections have been few and far between. But we’ve seen lulls before, and the virus has always returned.


The H5N1 virus is not a single entity. Instead it consists of billions and billions of individual viruses, inhabiting thousands, perhaps hundreds of thousands of hosts simultaneously. Mostly birds, but also apparently some mammalian species (dogs, cats, ???) , and of course, the occasional unlucky human. Each host is like a separate mutation factory, with new versions of the virus constantly evolving.


Most of these mutations are dead ends, or simply favor the status quo.


A small number of these mutations propel the virus towards a more `human adapted’ pathogen. These changes are most likely to occur in infected humans, but can occur in any host. But it isn’t enough that a favorable mutation occur. That mutation must occur in a host that is in a position to pass it on, otherwise it dies with the host.


It is therefore folly to think that the virus has moved, en masse and lock-stepped, into oblivion. Over years, perhaps, we could see that kind of shift, but not overnight.


The second possibility is that this is simply a seasonal downturn. It is now summer in the Southern Hemisphere, a time of low flu activity, and the flu season is just getting started in the Northern Hemisphere. We’ve seen lulls before, and then watched the H5N1 virus take off with a vengeance last January, and rage for five months before quieting down for the summer. It was in May of this year, if you recall, when the spike in human cases occurred in Indonesia.


This could simply be the lull before the storm.


The third possibility is that there are more cases out there than we are hearing about, and despite the conspiratorial tone of that; it is highly likely.


Most of the countries thus far affected have marginal, and in some cases nearly non-existent surveillance capabilities. People die in remote areas of the world every day, and often, they never see a doctor. Death is no stranger to residents of third world countries, and when it comes, families, and villages often quickly bury the dead and move on.


It would be all too easy for a great number of cases to go unnoticed.


And even in areas where testing is ongoing, we know the tests are unreliable. The nasal and throat swabs have an abysmal record of picking up the virus, and that continues to be the standard method used in many countries to rule out avian flu. If a patient dies, and tested negative for the H5N1 virus, it is all too easy to blame some other cause, and bury the case.


There are also strong motivations not to report suspicious deaths, of humans or of birds, in many regions of the world. For many poor villagers, their chickens are their only form of wealth and a major component of their diet. To report sick chickens is to invite the authorities to come in and cull them, along with the healthy ones in the vicinity, which would be a devastating blow to their hardscrabble existence.


And in some countries, authorities have shown resistance in the past to admit when they have an avian flu problem. It is bad for tourism, bad for business, and in some places, has resulted in persecution of whistleblowers from the central government.


While the news is slow, the action in the background, by governments worldwide, continues to escalate. Countries are still stockpiling antivirals, and vying for a limited production of experimental vaccine. Drills are being held by public, private, and military organizations all over the world.


The level of concern at the highest levels has, if anything, gone up.


So while we should be thankful for this lull, and use it to our advantage, we need to be aware that the virus could rear its head again anytime, almost anywhere in the world.


This is a time for continued preparation, and vigilance.


Not for complacency.