Note: According to this AP article new strains of viruses get their start in rural Asia. If that is
accurate what factors account for it? Historically, it seems some of the worst viruses and
diseases have come out of China. Although there is some dispute my general understanding is
smallpox was brought to Europe from China. Does their overpopulation and cultural practices
encourage a viral medium? I know in the case of SARS Chinese government officials were aware
of this new potentially deadly virus and their response was a news black out. In this age of
most likely emerging plagues the last thing called for is government secrecy. Getting crucial
information out as soon as possible is more important than worries about tourism or investment
being hurt.
The Associated Press
NEW YORK - As bad as this year's flu season is, it hasn't brought the worldwide outbreak known as a
pandemic. But experts warn that a pandemic is coming, it's just a question of when.
"It's going to happen," said Dr. Greg Poland of the Mayo Clinic. "For the American public in
particular, I think it will be horrific."
Many Americans haven't experienced the overwhelming crush of patients at hospitals and doctors'
offices and the widespread fear a flu pandemic could bring. And by historical pattern, Poland said
it's about time for the next one. There have been three in the past 100 years, igniting in 1918,
1957 and 1968. There's no way to predict when the next one will appear, but the pattern does give
experts pause. It's all up to a virus that is variable and fickle, constantly changing its genetic
makeup, and the time when it hits upon a combination that lets it take off worldwide is a "roll of
the genetic dice," said Dr. William Schaffner of Vanderbilt University.
So the lack of a pandemic in the past 35 years basically means "the genetic dice haven't been rolled
that way," Schaffner said. "While we're grateful for that, it makes us nervous."
There's plenty to be nervous about. It's estimated that in the industrialized nations alone, the
next pandemic is likely to send 1 million to 2.3 million people to the hospital and kill 280,000 to
650,000, according to the World Health Organization. Its impact will probably be greatest in
developing countries.
As a practical matter, flu shots probably could not be counted on to prevent a pandemic. For one
thing, pandemic virus strains emerge unexpectedly, and there would probably not be enough time to
recognize the threat and then provide vaccines that target them, Schaffner said. What's more, many
countries outside the United States wouldn't have the means to give enough flu shots to stop the
spread, Poland said.
Dr. Robert Couch of the Baylor College of Medicine noted that health authorities are making major
efforts to prepare for controlling a pandemic, including putting an emphasis on developing and
manufacturing vaccines faster and in greater quantities.
The pandemic of 1918-19, known as the Spanish flu, sickened an estimated 20 percent to 40 percent of
the worldwide population, with a death toll believed to exceed 20 million. In the United States
alone, some 500,000 people died. An ordinary flu epidemic kills an average of 36,000 Americans.
The next pandemic, the Asian flu of 1957-58, killed about 70,000 in the United States, while the 1968-
69 Hong Kong flu led to about 34,000 deaths in the United States.
New strains of the flu virus, and so potential pandemics, get their start in rural Asia, where the
various strains that infect chickens and other birds, pigs and humans can mingle. That gives them a
chance to swap genetic information as well as mutate on their own.
The potential spark for a pandemic occurs when that environment produces a new virus that infects
people and bears surface proteins that people's bodies have never seen before. That means people
have no natural defense against it.
In contrast, ordinary outbreaks like this year's come from a virus that has changed only slightly
from previous ones, so that the population it enters still has some natural immunity from encounters
with the previous germs.
But the genetic shift alone is not enough to launch a pandemic. In addition, the new virus must
acquire the ability to pass easily from person to person, either by random genetic change or by
picking up genetic material from a previous human flu virus.
The world has had some close calls in the past few years, says Richard Webby of St. Jude's
Children's Research Hospital in Memphis. In 1997, a bird flu in Hong Kong jumped to people, killing
six. But the virus never developed the ability to pass easily from person to person, Webby said.
Hong Kong authorities slaughtered 1.4 million chickens to end the threat. Just this year,
authorities became alarmed when a father and son in Hong Kong were hospitalized because of a bird
flu virus, and when flu virus infected some workers in the Netherlands who had slaughtered infected
chickens. The Netherlands outbreak was contained by anti-flu drugs and fast vaccination, and
slaughter of the poultry, Webby said.
Scientists have been noticing a lot of flu virus in chickens and pigs globally, and a lot of variety
in the strains, which is worrisome, Webby said. It's impractical to develop vaccines against all the
animal strains in case they jump to humans, and there's no reliable way to identify the most
hazardous ones, he said.
When the next pandemic shows up, experts say, it will find a population with many more vulnerable
people like the elderly, infirm and those with weakened natural defenses than were living 35 years
ago. It will also find a trimmed-down hospital system with fewer beds to handle a surge of patients.
And while today's anti-flu drugs will probably attack the new strain, that's not yet clear. Supplies
of the drugs and vaccines would be strained.
But still, with the improvements in health care since the last pandemic, might the next one be
less serious?
"I want to believe that," Poland said, "but we won't know until it happens."
Copyright 2003 The Associated Press.