Intelligence

Bird Flu Killed 300 in China, Says Unofficial Report

The Epoch Times | Bird Flu Killed 300 in China, Says Unofficial Report

Details Disputed, but Official Numbers Likely Just Tip of the Iceberg
By Jan Jekielek
Epoch Times Thailand Staff
This report is an update to the November 24 original, Bird Flu Killed 300 in China, WHO Expert Says, with possible inaccuracies corrected and information current as of November 26.

The bird flu has killed 100 times more people than Chinese officials admit, said an unofficial report presented by a World Health Organisation (WHO) avian influenza expert on November 20.

WHO bird flu consultant Dr. Masato Tashiro presented this unverified information, received from China via "private channels," to a room of the world's top virologists, while speaking at the University of Marburg in Germany.

According to the data, at least 300 people have died from H5N1 bird flu in China and 3000 have been infected including seven cases of human-to-human transmission, reported the German newspaper Frankfurter Allgemeine Zeitung (FAZ).

The implications of these numbers, if confirmed, are staggering. They point to an active human H5N1 epidemic in China.

Dr. Tashiro, head of the Department of Virology at the Japanese National Institute of Infectious Disease, and Director of the WHO Collaborating Center on Influenza at the Tokyo National Institute of Infectious Diseases, was reported by FAZ to have said that the West is being "systematically deceived" by Chinese authorities, and that he believes that the numbers he presented are from a reputable source. FAZ also reported that Dr. Tashiro compared the situation to Beijing's 2003 SARS cover-up, adding that five Chinese medical workers were detained by authorities for trying to report on the bird flu.

However, Dr. Tashiro later denied these claims. "I clarified [at the meetings] that I do not know the original sources and I cannot confirm whether they are true, how these numbers were derived and what laboratory tests and epidemiological investigation were done," he wrote in a letter to the ProMED-Mail website hosted by the International Society for Infectious Diseases on November 24, stating flatly that he never said that he believed the data, nor claimed deception on the part of the Chinese authorities. Dr. Tashiro also told ProMED that his recent visit to China was not as part of an official WHO delegation.

Meeting attendee Professor Hans-Dieter Klenk of the University of Marburg confirmed that Dr. Tashiro presented data to the effect of 300 human deaths, according to Israel's Haaretz daily. Klenk also denied the FAZ reports of Dr. Tashiro's claims of cover-up by Chinese authorities, supporting Dr. Tashiro's letter to ProMED.

Case Closed?

While it is possible that the FAZ reporter sensationalized the story of Dr. Tashiro's presentation in Marburg, such a report from a high-level WHO official bears thorough examination.

"Due to poorly organized surveillance and information sharing systems in many affected countries including China, it is reasonable to consider that more cases have occurred actually," Dr. Tashiro wrote to ProMED, explaining the take-home message he had hoped to deliver to his Marburg audience. Because the official numbers reflect only the laboratory-confirmed cases, he sees them as being only a small subset of the actual number of cases, what he called "an iceberg phenomenon."

"In this context, I talked about a few examples of non-authorized information and rumors…which I received through private channels," he wrote.

Until recently, Chinese authorities didn't allow for any independent analyses of their bird flu test results, and didn't share the details of their data. It was only with the entry of WHO personnel onto the Chinese bird flu scene that the first cases of H5N1 in humans were confirmed in China. This led the WHO to commend Beijing for being forthcoming with the realities of China's avian influenza. Officially, there have been just three bird flu deaths from 23 active bird flu outbreaks in birds across China.

However, numerous unconfirmed lines of evidence suggest that a bird flu epidemic in humans has been happening in China for quite some time. Several unofficial Boxun.com reports have suggested human bird flu deaths in the hundreds, with military-imposed quarantines and media blackouts attempting to contain both the disease and the knowledge of the damage it left in its wake.

Even bird flu outbreak reports in wild waterfowl were met with censorship. An influenza research centre was closed after it published thorough findings of an H5N1 outbreak in China and suggested that the disease would spread via migratory pathways to Europe – precisely what ended up happening last month. The Epoch Times documented these lines of evidence as early as last July.

According to the official WHO tally, as of November 25 there were 132 laboratory-confirmed cases of bird flu in humans, resulting in 68 deaths. The vast majority occurred since last December, and all were in Asia. Adding Dr. Tashiro's numbers to this would demonstrate an average H5N1 infection rate across the subcontinent 20-times-greater than was previously known.

With an ongoing rise in the avian influenza human death toll in Thailand, Vietnam, and Indonesia over the past two years, there is no reason to believe that China would have been spared similar cases. Perhaps the only good news from Dr. Tashiro's figures would be that they suggest a much lower death rate than those implied by the WHO stats – 10 percent instead of 50 percent.

Irrespective of whether the report that Dr. Tashiro presented is confirmed, it is still very likely that the official numbers are only, as Dr. Tashiro suggests, the tip of the iceberg.

November 26, 2005 at 05:46 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

Focus: Atishoo, Atishoo, we all fall down?

Focus: Atishoo, Atishoo, we all fall down? - Sunday Times - Times Online

Focus: A deadly bird flu, lethal to some animals, is spreading towards Britain. How serious is the threat to humans and what can be done to counter it? Jonathan Calvert, Sarah-Kate Templeton and Will Iredale report
It is the drug of the moment and Ken Livingstone, the London mayor, has ordered 100,000 courses of it. Several British companies are believed to be building stockpiles. Some individuals are said to be paying three times the retail price trying to buy illicit supplies through overseas websites.

The drug is Tamiflu, a prescription antiviral medicine thought to be the only protection available against a potential doomsday virus winging its way towards Britain.

Earlier this month a deadly bird flu, which has been spreading out from Asia, reached Russia. Yesterday a suspected case was reported in Finland, but the exact strain is not yet clear.

The H5N1 virus has killed tens of millions of animals, particularly chickens in Asia, but also other species. So far the strain has infected very few humans — only about 120 — but in those it has attacked it has been highly lethal. Half of them died.

The fear is that H5N1, like all flu viruses, will continue mutating and could turn into a strain that infects humans and passes from one person to another as easily as the common cold.

“If we do get human-to- human transmission, millions will die,” said Dr Nigel Higson, chairman of the primary care virology group.

“With huge numbers of people using air travel, it will move round the world very quickly. A large proportion of people in Africa would die. In western countries where we will hopefully have an avian flu vaccine and antivirals, 25% of the population will be infected and the death rate will be between 3% and 10% of the population. The fatalities will not just be the sick and elderly.”

Experts believe such a pandemic could cause a catastrophe on the scale of the 1918 Spanish flu that killed 50m people in 18 months.

Last month the Department of Health invited manufacturers to tender for a contract to develop and supply a vaccine against the strain. It is also spending up to £100m buying 14.6m courses of Tamiflu — an indication of how seriously it is taking the threat.

There is one big unknown: whether the virus can or will become transmissible between humans. Scientists have little evidence that it can do so at present and nobody knows whether it will be able to do so in the future.

“Although we expect this virus to become a pandemic we have no proof as yet that it will happen,” said Higson.

“To have a pandemic we have got to have a new virus.”

FLU is one of the most mutable viruses in the world, constantly shuffling its array of genes into new forms. The type known as H5N1 is thought to have originated in ducks from the Guangdong province of China in the late 1990s and drew particular attention because it proved devastating in poultry.

Almost every chicken that contracted H5N1 was dead within 48 hours. In 1997 the first human cases emerged during an outbreak on poultry farms in Hong Kong. Eighteen people suffered respiratory infections and six died.

Although more than 1.5m chickens were slaughtered in Hong Kong in an attempt to eradicate the virus, it managed to survive elsewhere — some animals can carry it without dying — and came back even stronger than before.

In January 2003 a tougher “Z” strain emerged in Thailand and Vietnam, capable of killing rats and later pigs. It also killed 45 tigers that were fed raw chicken in Thai zoos; more than 100 others had to be destroyed after becoming infected. National authorities ordered the slaughter of more than 120m chickens as the strain spread to Cambodia, China, Indonesia and Malaysia. This summer more than 120,000 poultry in six regions of western Siberia were destroyed after the discovery of H5N1.

Wild species — in particular bar-headed geese — were found to be infected in Siberia and Mongolia, which witnessed the mass deaths of birds around Lake Erhel in its Huvsgel province.

Several experts feared that the outbreaks had brought the virus within range of Europe through the flightpaths of migrating birds.

In Holland — where a similar avian flu outbreak five years ago led to 30m chickens being culled — officials last week compelled farmers to bring all their poultry indoors.

John Oxford, professor of virology at Queen Mary’s School of Medicine in London, called on Britain to take similar precautions and Bob McCracken, president of the British Veterinary Association, warned that migrating birds would “inevitably” carry bird flu to the UK at some stage.

However, Debbie Reynolds, the government’s chief veterinary officer, was more cautious after discussing the threat with European Union experts last week; she said the risk of the virus reaching Britain was “remote or low”.

Nevertheless, wildlife is being monitored around the country for any sign of avian flu. If it does arrive it could could easily spread across a range of wild birds — waterfowl are particularly vulnerable — and other animals.

Nor is it simply a problem for the countryside: many migrating birds land at wetlands near cities, such as Barnes, west London, and Martin Mere near Liverpool. Domestic cats that eat H5N1- infected birds could catch the virus, as has proved to be the case in Thailand.

So far studies of the virus’s human victims have concluded that they mostly contracted H5N1 through close contact with diseased or dead birds. The virus is found in both the faeces and raw meat. Most infections have occurred during the slaughter and defeathering of poultry for cooking. It is common in Asia to buy a live chicken at the market and take it home to eat.

Over the past year health officials in Thailand and Vietnam have also investigated three cases that could be the first evidence of transmission between humans.

In each case the victims had cared for an infected family member and then developed the virus several days later. Health officials have not ruled out the possibility that the virus was transmitted by a shared meal or some other exposure in the home.

If there is any human-to- human infection it is extremely limited at present and it is notable that previous H5-type flu viruses have not generally been transmissible between humans.

However, all three global influenza pandemics in the past 100 years have been linked to strains of bird flu that adapted to humans. While scientists emphasise that this risk is always present, they are particularly concerned now because the H5N1 virus is so lethal.

Victims suffer coughing, headaches, fever, dizziness, diarrhoea and internal bleeding. The autopsy of one child who died from the disease last year is reported to have shown that his lungs had been “torn apart” as his natural defences tried to fight the virus.

Professor Neil Ferguson, an expert in flu epidemics from Imperial College London, said: “This particular bird flu variety generates more severe diseases in humans than most bird flu varieties. It would be more like the 1918 type of pandemic than the 1957 or 1968 pandemics . . . that is potentially a very severe event.”

There is also a belief among some experts that pandemics are cyclical and the next is overdue. Forecasting of such catastrophes, however, is an imprecise science. A mutation turning the virus into a form more infective to humans could happen anywhere in the world — or the virus might become less lethal or, indeed, it might not happen at all.

Health officials have cried wolf about flu before and been wrong. When a soldier suddenly died from swine flu in the US in 1976, experts feared an epidemic, predicting that 1m Americans might perish.

President Gerald Ford ordered a mass vaccination of Americans despite the doubts of drug companies over being able to produce enough vaccine swiftly and safely. The flu epidemic never materialised and the US government paid $90m to claimants who suffered serious side effects from the vaccine.

IN judging how to react there are other factors to consider, too, principally the practical limits on protecting yourself. At present there is no licensed vaccination against H5NI and there is not likely to be one in the near future.

Three weeks ago the National Institute of Allergy and Infectious Diseases in America reported initial success in trials on a vaccine developed by Sanofi Pasteur, the pharmaceutical company. But the vaccine has yet to receive regulatory approval, which could take months.

It would also take years to produce enough vaccine to immunise the whole of Britain, and by then the virus strain could have changed out of recognition.

Marie-José Quentin-Millet, head of research at Sanofi Pasteur, describes its new vaccine as merely a “dress rehearsal” to build scientific knowledge so that it can be adapted if and when a strain of the virus more infective to humans emerges.

In reality, it is likely that a flu epidemic could be months old by the time anyone gets a vaccination. Even if a suitable vaccine could be produced, few doses would reach the general public. A report by the Department of Health says: “International demand for vaccine will be high. Vaccine will have to be distributed equitably and administered to predetermined priority groups first, according to nationally agreed recommendations.”

The priority groups set out in the report are frontline health workers followed by vital services such as police officers, firemen, the army and undertakers. Most of the population are very unlikely to be offered a vaccine. Given these limitations, the health department has chosen to make its block purchase of Tamiflu. Made by Roche, the drug can be used to protect against contracting the virus or to alleviate the symptoms of those already infected. The full order of 14.6m doses ordered by the health department will not be delivered until March 2007. At present the government has a stockpile of 900,000 doses and they would be offered first to the priority groups. For this reason several organisations are trying to acquire their own stocks, including the London mayor’s office, which spent more than £1m buying antivirals to protect key workers in the capital. Doctors advise strongly against individuals hoarding drugs. “If individuals stock up with pre-orders, the medication will not be there for those who need it when there is an outbreak,” Higson said. There is another problem, too: many of the people who have been infected by bird flu were given Tamiflu, yet they still died. So in the absence of medication, what else could you do if there were an outbreak? According to the contingency plan people would be advised to avoid public transport, crowds, long queues and anywhere else they might encounter carriers of the virus. Most effective, it seems, will be to stay at home and wait until the outbreak is over.

Additional reporting: Nicci Smith, Brussels

August 28, 2005 at 11:16 AM in Flu pandemic watch | Permalink | Top of page | Blog Home

Avian-flu pandemic 'inevitable'

TheStar.com - Avian-flu pandemic 'inevitable'

DAVID BROWN
SPECIAL TO THE STAR

Robert Webster is watching his long-held hunch about the origin of pandemic influenza play out before his eyes. It would be thrilling if it were not so terrifying.

Four decades ago, Webster was a young microbiologist from New Zealand on a brief sojourn in London.

While he was there, he performed an experiment showing that the "Asian flu" microbe that had swept the globe in 1957 bore an unmistakable resemblance to strains of virus carried by certain birds in the years before.

Webster's observation was a surprise — and a troubling one, suggesting an origin of the unusually virulent strains of influenza virus that appear two or three times each century.

His hunch, that at least some of these pandemic strains were hybrids of bird and human flu viruses, was correct.

Since then, Webster has become arguably the world's most important eye on animal influenza viruses.

These days, he is deeply worried about what he's seeing.

Strains of an influenza virus known as A/H5N1 (the first letter denoting influenza A, an adaptable virus widespread in the animal world) have been spreading in wild and domestic birds across Asia since 1996. In recent weeks, the virus has struck Siberia and Kazakhstan.

Since late 2003, about 100 million domesticated birds — mostly chickens and ducks — either have died of the virus or have been killed to keep the viruses from spreading. But what worries Webster and other experts is that in 112 confirmed cases since 2003, at least 50 people infected with the H5N1 "bird flu" have died — yielding a fatality rate that outstrips any human flu epidemic on record, including the epochal Spanish flu of 1918 and 1919 that killed at least 50 million people.

Webster's insight about the origins of pandemic flu led to an unavoidable conclusion: If scientists had any hope of preventing a pandemic, they had to keep watch on influenza in many species, not just humans.

At 73, Webster heads a team of four principal investigators and a dozen graduate students at St. Jude Children's Research Hospital in Memphis, where the New Zealand native has worked since 1968.

The lab has chambers for handling high-risk pathogens and uses nearly 3,000 fertile chicken eggs a week for growing influenza viruses.

Elsewhere on the St. Jude campus is a small plant licensed by the U.S. Food and Drug Administration to make experimental vaccines. The "seed strain" of virus used to make an H5N1 vaccine now in human trials in the United States was made at St. Jude.

Since 1997, Webster also has spent three months a year as a visiting professor at the University of Hong Kong. That gets him closer to the historical breeding ground of new flu strains: China.

With H5N1 steadily gaining momentum this year, he has returned to Asia twice since his Hong Kong stint ended in March. One trip was to brief prime ministers of the Association of Southeast Asian Nations about what they can to do to stanch the spread of H5N1.

The World Health Organization "will help in the initial outbreak," he says he told them.

"But if it breaks through, guys, you're on your own."

Webster thinks an avian-flu pandemic "is just inevitable. One of these is just going to blow."

For nearly 30 years, he and his colleagues have annually sampled wild ducks in the birds' nesting grounds in Alberta, looking for new flu strains. Since 1985, they have also sampled the feces of more than 5,000 migrating shorebirds along Delaware Bay.

H5N1 strains with slightly different traits have appeared several times in East Asia since the first one emerged in southern China in 1996. Last fall, while analyzing a strain circulating after an outbreak in Hong Kong in 2002, one of Webster's researchers, Diane Hulse, made an unusually important observation.

Many ducks experimentally infected with the virus didn't die, even though the strain was highly lethal to chickens.

But one of the duck viruses was highly lethal to ferrets, the animal whose susceptibility mirrors that of people. This meant that killing infected chickens wasn't going to be enough to stop the spread of the microbe. Ducks could serve as a permanent reservoir of H5N1 virus.

The discovery by Hulse and Webster led in part to an extreme program Thailand mounted last November. About 70,000 investigators went into every village in the country looking for sick ducks and sampling the feces of healthy-looking ones. Flocks carrying H5N1 influenza virus were killed.

The strategy appears to have worked. Last year, Thailand had 12 human deaths from H5N1 flu. So far this year, it has had none.

Stretching out before Webster and public health experts is a long list of chores the world must complete if it is to abort the bird-to-man transfer of disease he long ago proved could happen.

Last month, two teams of scientists based in China, one assisted by Webster, proved H5N1 is now circulating in several species of migratory birds capable of carrying the virus to India, Australia and Central Asia.

A task equal in importance to charting the spread of H5N1 is developing and distributing a good duck vaccine for the billions of those birds in East Asia.

Those countries, which collectively are the likely ground zero of pandemic flu, also need to improve their disease surveillance. In particular, they need to develop laboratories capable of safely isolating and testing influenza viruses.

And while they are doing that, they — and the rest of the world, Webster believes — would be well advised to draw up a plan to limit human movement and distribute vaccine and antiviral drugs should a pandemic flu strain emerge despite the efforts to prevent it.

It's a long list with an uncertain deadline, and it's enough to keep Robert Webster at work.

Washington Post

August 28, 2005 at 10:45 AM in Flu pandemic watch | Permalink | Top of page | Blog Home

GTA gets ready for flu pandemic

TheStar.com - GTA gets ready for flu pandemic

If one million people ill, outbreak could cripple the region
Health officials will meet next month to discuss their plans

RITA DALY
STAFF REPORTER

Every public health unit, hospital, town and city in the GTA is getting ready for a flu pandemic, officials say.

"There's a lot of things going on and have been going on for a long time," said Dr. Michael Gardam, head of infection control for the University Health Network and a key player in pandemic preparedness plans.

"I can say honestly, pandemic flu has taken up probably half my time in the last year."

Among the issues being considered are: the ability to staff hospitals, the need for triage centres to access ill people, alternative care facilities to deal with large numbers of sick people, the development of a volunteer management plan, morgue capacity and absenteeism.

"People have to realize everything we do in life will be affected by this," Gardam said yesterday.

Hospitals, nursing homes, school boards, ambulance services, business and government are working together to limit the impact of any pandemic in the GTA.Gardam said there's only so much that can be done to limit its destruction, which is why preparation is so important. And plans are being readied across the region.

In Toronto, public health officials have been discussing how to battle a pandemic since late 2002, with a pause in 2003 while the city wrestled with the SARS outbreak.

"Our job as public health officials is to make the assumption that it's going to hit," said Councillor Joe Mihevc, a member of council's board of health. "We want to be prepared."

A steering committee has been created with representatives from public health, hospitals and police and fire conducting monthly meetings. And business leaders have been alerted to the risk that a new flu virus could cause skyrocketing absenteeism, changes in demand for goods, decreased travel within the city and have other effects.

Next month, officials will hold a town hall meeting that will discuss ways of battling a possible flu outbreak.

Fears of a global outbreak have risen since the avian virus spread recently from Asia into Siberia in eastern Russia and Kazakhstan.

Health Canada, in its pandemic report released last year, estimates up to one-third of the population could fall ill and more than 50,000 people could die as a result of a pandemic.

About 1 million people in the Greater Toronto Area could fall ill, with at least 420,000 requiring medical treatment. Another 7,000 to 8,000 would need in-hospital care.

By comparison, 375 people in the GTA were sick with SARS.

In Peel Region, health officials are developing a plan that would co-ordinate their efforts with those of police and government, and also create a mechanism for informing the public about possible health risks.

Officials are also looking at measures to prevent an outbreak at Pearson airport. Airports can be points of entry for diseases.

"The region takes this matter very seriously, given that (Pearson) airport is within its jurisdiction," said Dr. Hanif Kassam, Peel's medical officer of health. "If there were to be a pandemic flu ... Peel would be at the hub of the pandemic."

And York Region has hired a full-time nursing manager to help combat any possible flu epidemic, said Dr. Helena Jaczek, medical officer of health for the region.

Gardam, who sits on the provincial and federal pandemic committees, said that a pandemic won't result in hospital closings or the screening of health-care workers.

But schools and businesses would be forced to shut down, which is why the Toronto public health authority is leading co-ordinating efforts and meeting regularly with various sectors.

with files from Alejandro Bustos and Paul Moloney

August 27, 2005 at 12:38 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

Bird flu kills rare civets in Vietnam

TheStar.com - Bird flu kills rare civets in Vietnam

HANOI, Vietnam (AP) — Bird flu has killed three rare civets born in captivity at a national park in Vietnam, marking the first time the virus has been reported in the species, officials said today.

The Owston civets died in late June at the Cuc Phuong National Park, about 120 kilometers south of Hanoi. Samples sent to a lab in Hong Kong came back positive for the H5N1 virus, said Scott Roberton, technical adviser for the civet conservation program at the park.

He said other animals at the park have been tested - including chickens, rats and other birds - but none have tested positive for the virus.

He said other animals at the park have been tested - including chickens, rats and other birds - but none have tested positive for the virus.

"It's another good example of how dangerous this thing is," Roberton said. "No animals are ill, no people are ill. We're still trying to figure out where the source was."

The civets were not fed any type of poultry, and 20 other civets of the same species in adjacent cages did not become sick, he said. The World Health Organization and Vietnam health officials are expected to test staff and animal keepers to determine if anyone caring for the civets has been infected with bird flu, he said.

Anton Rychener, head of the U.N. Food and Agriculture Organization and the World Organization for Animal Health in Hanoi, confirmed the results.

Cat-like civets are captured in the wild and served as a delicacy at restaurants in Vietnam and China.

Scientists suspect that SARS, or Severe Acute Respiratory Syndrome, which killed nearly 800 people worldwide in 2003, was passed to humans from civet cats and other mongoose-like animals sold in live food markets in southern China.

Peter Horby, an epidemiologist for the WHO in Hanoi, said the development would not make people more susceptible to bird flu because humans have less contact with civets than poultry.

"The interesting thing is that it's a new species," he said. ``It continues to surprise."

Bird flu had previously been found in other mammals, such as cats and tigers.

The virus has killed 61 people regionwide, with the bulk of those deaths in Vietnam. Health experts have repeatedly warned that the world is due for an influenza pandemic that could kill millions and cripple economies. They fear the bird flu virus will mutate and become easily transmitted from person to person. So far, most human cases have been traced back to contact with poultry.

Owston civets are globally threatened and found in southern China, Vietnam and Laos.

August 27, 2005 at 12:22 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

Deadly flu: `The only question is when'

TheStar.com - Deadly flu: `The only question is when'

Avian's arrival called inevitable
Experts fear global pandemic
Not if, but when for outbreak of disease: Experts

Avian flu virus is possible candidate for global infection

LYNDA HURST
FEATURE WRITER

The deadly avian flu virus is slowly but surely making its way around the world.

It now appears all but inevitable that it will arrive in North America this year or next, via migrating birds or, more likely, unwitting travellers, as with SARS in 2003.

The virus has already ravaged the poultry stocks of Southeast Asia and millions of peoples' livelihoods. It has also begun to kill other animals, including pigs, tigers and civet cats.

More forebodingly, if still only sporadically, it has crossed over into humans.

In the last two years, at least 109 people have caught the respiratory virus after being in close contact with diseased poultry. With little or no immunity — and no vaccine — about 60 of them died. Perhaps more.

China isn't saying, though it was there that this year's outbreak began, in April, with 6,000 dead wild birds.

The threat is now on Europe's doorstep, poised to enter when infected wild geese and other birds start migrating out of Russia.

The virus was detected there this month in regions as far apart as Siberia and the Caspian Sea.

When and how the virus will hit North America is unknown.

But if a global pandemic is in the cards, there is nothing anyone can do to stop it.

The loss of human life even in a mild pandemic would be devastating; anything more virulent, catastrophic. The cost of a world economy in shambles for several years can only be imagined, say analysts.

Margaret Chan, chief of influenza pandemic preparedness at the World Health Organization, no longer talks about if it is going to happen:

"The only question is: When? I don't think anybody has the answer to it. We have to be on the lookout for it any time, any day."

Specifically, scientists have to be on the lookout for human-to-human transmission of the H5N1 virus, the most lethal of the 16 known strains of bird flu. Once it occurs and is, with luck, detected, the frantic race against time will begin.

It is essential to stop the virus dead in its tracks as soon as it is picked up. Surveillance is key, says Alison Stewart, director of emergency planning at the Ontario Ministry of Health.

"If there's a pandemic, we won't be able to hold it off, so it is really important to contain it to buy time for a vaccine to be developed and distributed."

It may shock the public to learn that no vaccine for H5N1 exists, though American researchers think they found a possible one this month. Most health officials suspect the already mutating virus will mutate further before it takes off among humans. Therefore, until the exact strain is known, a demonstrably effective human vaccine can't be created.

"The U.S. has a `candidate' for a vaccine," says Dr. Paul Gully, Canada's deputy chief public health officer. "They're hedging their bets and going ahead with manufacturing it. But Canada isn't making a commitment to it."

Ottawa may obtain the "seed strain," however, to have in place if the American vaccine does prove viable.

Canada's Public Health Agency has had a contract since 2001 with ID Biochemical for it to launch into immediate vaccine production when the alarm is rung. Only problem is, it will take six weeks to three months to produce the first dose.

The only weapon during that time will be an antiviral drug, Tamiflu. Canada, like most Western nations and WHO itself, has been stockpiling it. Ottawa has bought 22.5 million doses; Ontario, 10 million.

But again, in this realm of unknowns, there is a problem. No one knows if Tamiflu, which retards the progress of ordinary human flu, will also work in the avian-human version.

"Our thinking is," says Stewart, "that even if it's not 100 per cent effective, it will provide some protection, slow down the spread in a person's system."

That doesn't mean doctors should start prescribing Tamiflu for people to hoard, as some already are. That threatens to deplete the available stock. The drug has been earmarked for the earliest patients, for health-care professionals, emergency and other vital workers, says Stewart. If it is misused by people with private caches, it could make the situation worse.

Dr. Carolyn Bennett, federal minister responsible for public health, warned this month that Tamiflu "is not for healthy Canadians to be keeping in their fridge until it is post-dated"

The people most at risk of getting the virus and potentially dying, she said, "aren't necessarily the people most able to buy the drug."

The most-at-risk are expected to be the frail elderly and the very young. But no one knows for certain. The 1918 Spanish flu epidemic that killed 40 million to 100 million people worldwide also started as a bird virus, and it targeted healthy young adults.

Either way, the delay in getting a vaccine and an effective treatment drug could endanger millions, even hundreds of millions, of people. To date, H5N1's human mortality rate is 50 per cent. No country will be safe.

If it happens.

Not everyone thinks it will. Ontario's former medical officer of health, Dr. Richard Schabas, is not convinced that H5N1 is a pandemic in waiting.

"Our science just isn't strong enough for us to know that and it's not strong enough for us to be making these kinds of alarmist predictions that we're hearing from WHO and others," he told the CBC last month.

"This is the third time WHO has told us were on the brink of an avian influenza pandemic. They said it in 1997 and they were wrong. They said it a year ago and they were wrong."

Others wonder if another "Y2K" fear-scenario is at work. In 1999, there was worldwide alarm that computer systems wouldn't be able to cope with the changeover to the new century. Billions were spent warding off an economically devastating global crash.

The crisis was averted. Many credited the pre-emptive action, but others questioned whether the threat had ever truly existed.

Could it be the same with H5N1?

No one is willing to take the chance: "If we sat back and waited for this to happen, it would be too late to tackle it," says Neil Ferguson, a leading British researcher.

His computer-modelling study, published in the journal Nature this month, found a bird flu pandemic could be controlled only if the first cluster of human-to-human infections are detected before they reach 50 cases. Within two days, quarantines, travel restrictions and medicines would have to be put in place.

Given the history of influenza pandemics — which occur about every 30 years, the last in 1968, all originating in birds — the planet is overdue, health officials say.

It is only common sense to prepare, and Canada has been meticulous. The federal plan was issued in February; Ontario's most recent plan was issued in June.

"And if the work is all for nought," says Stewart, "fabulous."

Her time won't have been wasted, she says. "Our mass immunization plan, for instance, can be used for other things, a meningitis outbreak, say."

Gully, at the national public health agency, vigorously agrees. Whatever happens with the current avian flu threat, the constantly updated federal plan will pay off in the future, he says.

"We've built on our vaccine capacity, surveillance capacity, diagnostic and communication capacities, and they're all applicable to other situations."

But if H5N1 does mutate and ignite among humans, he says, "Canada is prepared to respond."

Canada is considered by world health officials to be well prepared, a legacy of the lessons it learned during the SARS outbreak, when 438 Canadians were infected with a previously unknown virus, and 43 died.

But only about 45 countries have pandemic programs ready to launch. And in poorer parts of the world, there is little or no public health infrastructure, let alone emergency planning.

"Even if there is a vaccine," says Gully, "how does it get distributed there?"

Farmers in Southeast Asia often sleep in the same room with their otherwise free-ranging chickens and ducks. They go to markets where live poultry is slaughtered on site. Wild birds that survive an infection in their intestines can excrete the virus for at least 10 days, and the virus can remain viable for two weeks in droppings — making it easy to spread in such sites.

The Food and Agriculture Organization has said for months Southeast Asia, the virus epicentre, needs more than $100 million to build up virus-control programs. Barely 10 per cent has been raised, mainly from the U.S. and the European Union. But it's not enough and not coming through fast enough.

The flypath that migrating birds will be taking down through Europe in the weeks ahead ends in North Africa, potentially striking that trouble-plagued continent as well.

If ever a crisis called for a global response, say officials, an avian flu pandemic is it.

There is no better example of a borderless world than infectious diseases, as former Canadian foreign minister Lloyd Axworthy recently wrote: "Viruses do not observe national borders, nor do they differentiate between the wealthy and the desperately poor."

Virus pandemics least of all.

In the calm before the potential storm, the challenge is to make Canadians aware of the threat without overly alarming them or causing public panic.

And that, says Gully, "is a real thin line."

For details on Ontario's pandemic preparation plan: http://www.health.gov.on.ca/

For the Public Health Agency of Canada `s plan: http://www.phac-aspc.gc.ca/new_e.html

August 27, 2005 at 12:19 PM in Flu pandemic watch | Permalink | Top of page | Blog Home

GTA firms join forces to fight flu pandemic

TheStar.com - GTA firms join forces to fight flu pandemic

Business leaders form advisory group
Examine methods for vaccine delivery

TYLER HAMILTON
BUSINESS REPORTER

Toronto's public health authority is setting up an advisory group of GTA business leaders this fall to explore ways of keeping the city's economic engine running in the event of a future flu pandemic, the Toronto Star has learned.

Meetings have already been held with key business leaders over the past few months, including those from the financial sector, and several large organizations are part of a pilot project to test a method for distributing vaccines to high-priority groups within large companies, such as providers of gas, hydro, and public transportation.

"There's an increase of interest from the business community," said Geri Nephew, lead manager for pandemic and influenza planning with Toronto Public Health. "We're helping them identify their risk with respect to pandemic influenza and what might be the impact on their business."

The impact could be huge.

Sherry Cooper, chief economist of BMO Nesbitt Burns, is predicting that, if a strain of the avian H5N1 virus that's spreading throughout Asia and eastern Russia in birds mutates to allow easy human-to-human transmission, the effect on the global economy would likely be "devastating."

Borders would close. Inventories would decline. Workforces would be crippled. Markets would plunge.

"Any disruption of the free movement of goods, services and people would undoubtedly spin into a decline in economy activity," Cooper said, adding the result would be negative growth of gross domestic product in most major regions of the world.

She said an executive committee and the board of Bank of Montreal have been busy working on emergency response plans in the event of pandemic-like events. "It's also my understanding that the other banks are doing this as well."

Toronto Public Health has been working on a pandemic influenza plan for the city since December 2002. It was put on hold in 2003 during the SARS crisis, but resumed in January 2004. The agency anticipates a final draft of the plan will be completed in October.

According to a recent staff report, "businesses in Toronto will be significantly affected by employee illness and absenteeism, changes in supply (and) demand of products and services, decreased travel within the city, and societal disruption."

Nephew said the working assumption is that 35 per cent of the population will fall sick in the event of a pandemic, but the impact on the workforce could be much worse because, "if there is a sick family member or sick child in the home, one of the parents is going to have to stay home. That's a reality businesses will need to think about."

What's clear is that some industry leaders haven't been thinking about it.

"This really hasn't been talked about at all. It just hasn't been on the radar screen," said Buzz Hargrove, head of the Canadian Auto Workers, the country's largest private-sector union. A pandemic would not only cause a major disruption in the assembly lines of Canada's auto manufacturing plants, it also could tighten borders and make it impossible to get the parts needed to assemble vehicles.

Companies that rely on just-in-time delivery of inventory would be hit hardest, said Donald Coxe, global portfolio strategist for BMO Financial Group.

He used the example of computer manufacturers that assemble products largely from parts out of Asia, such as Dell Inc. "What you'd have for that industry would be chaos completely let loose."

Sensing a need for better education and awareness in the business community, Philadelphia-based medical consultancy International SOS, which has an office in Toronto, launched a service this month that helps corporations plan for pandemics.

Its customer base is a who's who of corporate Canada, including telecommunications giant Nortel Networks Corp., and so far a handful of Canadian companies have already signed up for its pandemic planning services.

Dr. Myles Druckman, vice-president of medical assistance for International SOS, said that, as governments worldwide put programs in place and begin stockpiling antiviral drugs to slow the spread of outbreaks, most businesses are just waking up to the issue.

"We're in the infancy stages," said Toronto-born Druckman. "Most companies are still getting their hands around this."

He said companies with exposure in current avian flu hotspots — such as China and South Korea — have shown most interest, largely because of fears about how an outbreak would affect their global supply chain. But companies doing significant business in Asia and relying on frequent travel to the region are also growing concerned.

Brampton-based Nortel, for instance, has cited China, India, South Korean and other Asia countries as high-growth markets and is significantly building up its presence in the region.

Nortel spokesperson Joanne Latham said the company has had a comprehensive business continuity plan in place since the SARS outbreak. She said the company, like many others, would likely resort to video and teleconferencing technologies to conduct "virtual meetings" and training sessions for customers, to cut down on travel and reduce person-to-person contact in the workplace.

"We would rely on that pretty heavily if a travel ban were to come into play," said Latham.

Druckman said planning measures could include the creation of basic workplace hygiene and infection-control policies to the development of "corpse management" guidelines for human resources departments, which would have to respond to and report potentially large death rates among employees.

SOS International has gone so far as to advise some companies — among them Coca Cola, Motorola and Exxon Mobil — to stockpile antivirus drugs such as Tamiflu, which the World Health Organization and dozens of national governments have begun to accumulate.

"Some organizations are doing this. Some are considering it. Others are not considering it," said Druckman. He would not say if any Canadian firms have engaged in the strategy.

Canada has about 22.5 million Tamiflu pills stockpiled, enough to treat roughly 8 per cent of the population.

Corporate stockpiling of Tamiflu, if the practice were to emerge, would likely call into question whether corporate interests and dollars are undermining government efforts to protect the general public.

Already, consumers are beginning to stockpile the antivirus drug, with Canadian and U.S. Tamiflu sales jumping more than three-fold in the past year.

Nephew at Toronto Public Health said there is nothing to stop Canadian firms from stockpiling drugs such as Tamiflu and no policies to encourage or to discourage the practice. "It would be their decisions."

Additional articles by Tyler Hamilton

August 25, 2005 at 08:11 AM in Flu pandemic watch | Permalink | Top of page | Blog Home