Table of Contents:

Foreword

Introduction

I. Storm Gathering

1. 1918

2. Master of Metamorphosis

3. H5N1

4. Playing Chicken

5. Worse Than 1918?

6. When, Not If

II. When Animal Viruses Attack

1. The Third Age

2. Man Made

3. Livestock Revolution

4. Tracing the Flight Path

5. One Flu Over the Chicken's Nest

6. Coming Home to Roost

7. Guarding the Henhouse

III. Pandemic Preparedness

1. Cooping Up Bird Flu

2. Race Against Time

3. Tamiflu

IV. Surviving the Pandemic

1. Don't Wing It

2. Our Health in Our Hands

3. Be Prepared

V. Preventing Future Pandemics

1. Tinderbox

2. Reining in the Pale Horse

Topics

References 1-3,199

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According to the WHO’s director of Communicable Diseases Surveillance and Response, “History has told us that no one can stop a pandemic.”653 But this is the 21st century; with enough advanced warning couldn’t a smoldering pandemic be stamped out, or at least controlled?

On April 1, 2005, President George W. Bush issued an executive order authorizing the use of quarantines inside the United States.654 The man in charge of preparing America for the pandemic is the Secretary of Health and Human Services, Michael Leavitt. “We would do all we could to quarantine,” says Secretary Leavitt. “It’s not a happy thought. It’s something that keeps the President of the United States awake. It keeps me awake.”655 This is a typical response, notes a medical anthropologist at the Center for Biosecurity, “Politicians will be under a lot of pressure to demonstrate that they are doing something.”656 Experts fear that not only would quarantines be wholly impractical and ineffective, they may even make matters worse.

The World Health Organization recommends against such measures in part given the impracticality of enforcement.657 “It shows a fundamental lack of understanding of public health emergencies,” says a Federation of American Scientists spokesperson. “I would be fascinated to see whether the president has a plan to quarantine a city like Washington, D.C., New York or Boston with so many roads in or out.”658

Following the 1916 polio epidemic in New York City, the head of the Health Department wrote that given the “countless instances of inconvenience, hardship, yes, real brutal inhumanity which resulted from the application of the general quarantine,”659 it was no wonder that so many people “developed a most perverse ingenuity in discovering automobile detours.”6600 The Federation of American Scientists spokesperson could not imagine how the quarantine could be enforced in this day and age. “Is he going to send in tanks and armed men?” he asked.661 Perhaps. President Bush has since asked Congress to give him authority to call in the military to contain the outbreak.662

This has some commentators worried. An op-ed in the Houston Chronicle asked, “If a health worker, drug addict or teenager attempted to break the quarantine, what would soldiers do? Shoot on sight?” Teenagers and health workers were found to be the prime violators of quarantine rules in Toronto during the SARS outbreak in 2003.663 Stating the obvious in regard to the difference between stopping the 1997 Hong Kong outbreak among chickens and stopping a human outbreak, experts have written, “Slaughter and quarantine of people is not an option….”664

“Even if it was possible to cordon off a city,” notes the Center for Biosecurity’s O’Toole, “that is not going to contain influenza.”665 Based on failed historical attempts along with contemporary statistical models,666 influenza experts are confident that efforts at quarantine “simply will not work.”667 “I think it is totally unreasonable on the basis of every pandemic we’ve had,” remarked a physician and flu researcher who worked with flu patients as far back as the 1958 pandemic.668 Experts consider quarantine efforts “doomed to fail”669 because of the extreme contagiousness of influenza,670 which is a function of its incubation period and mode of transmission.

SARS, in retrospect, was an easy virus to contain because people essentially became symptomatic before they became infectious.671 People showed signs of the disease before they could efficiently spread it, so tools like thermal image scanners at airports to detect fever, or screening those with a cough, could potentially stem the spread of the disease.672

The influenza virus, however, gets a head start. The incubation period for influenza, the time between when you get infected and when you actually start showing the first symptoms of disease, can be up to four days long.673 During this time, we are both infected and infectious. Just as those with HIV can spread the virus though they may appear perfectly healthy, at least 24 hours before any flu symptoms arise we may be exhaling virus with every breath.674 As many as half of those infected may never show symptoms at all, but may still shed virus to others.675

Some respiratory diseases seem only to be spread by droplets of mucus and therefore are not airborne in the truest sense. These aerosolized globs of mucus—though tiny—eventually settle to the floor and are not spread very far. Bird flu, on the other hand, can truly take wing. Influenza viruses in general, though predominantly spread by larger droplets, may also travel on microscopic residual specks of evaporated droplets less than a few millionths of a meter in diameter. These “droplet nuclei” can float suspended in air like particles of perfume676 and hence may spread through ventilation systems.677 Some investigators have even issued the dubious speculation that airborne viral transmission of influenza can occur over thousands of miles on intercontinental wind currents driven by low pressure weather fronts.678