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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Imperial College pandemic simulation of Thailand

The only way to truly stop a pandemic, it has been suggested, is to stamp it out at its source.2131 Once it starts, according to the editorial board of the journal of the Canadian Medical Association, “School closure, quarantine, travel restrictions and so on are unlikely to be more effective than a garden hose in a forest fire.” But every forest fire starts with a spark. Some experts believe that, at least theoretically, if caught early enough, a pandemic ember could be extinguished. It’s like a spark and a squirt gun, suggests the director of the U.S. National Vaccine Program. “If you aim properly you can get the spark and be done with it. If you miss, though, the fire is going to spread and there is nothing you can do to stop it.”2132

Two independent mathematical models—one out of the Imperial College of London,2133 the other from Emory2134 —were published in 2005 suggesting that under the right conditions, a pandemic outbreak might be able to be snuffed at the source in a matter of months. If their approach worked, instead of half the world becoming infected, less than 150 individuals might succumb.2135 The strategy—called “ring-fencing” or “ring tamifluation”—would be to surround the outbreak at its source and smother it by blanketing everyone in the area with antiviral drugs.2136 “Basically,” wrote one of the lead biostatisticians, “you contain it at the source or you fail.”2137

There are caveats. The models assume that the outbreak is rapidly detected and reported while still in limited human clusters restricted to a small geographical area. The virus would have to be caught before it gets highly contagious.2138 As many as 30 million tablets of Tamiflu would have to be immediately shipped in and effectively distributed throughout a potentially sprawling region.2139 No one could be allowed in or out.2140

That’s the computer model. In the real world, odds are the outbreak would not be detected in time—countries in Southeast Asia tend to have poor surveillance capabilities and are reluctant to admit outbreaks even when detected.2141 “If you can’t do it with the speed of a smoke alarm and a fire truck, you don’t have a chance in hell of stopping this,” Osterholm told a reporter.2142 As one blog commentator remarked, “Perhaps a computer model of how to contain ‘flying pigs’ is in order.”2143

The biggest chink in our armor may be lack of clinical surveillance and rapid detection.2144 To even theoretically stop a pandemic, the Imperial College model necessitates discovering the incipient pandemic when there are just 30 human cases. In the Emory model, the world would have about 21 days to intervene.2145 “The chances of that happening,” admits Secretary Leavitt, “are not good.”2146 Countries like Vietnam, Cambodia, and Laos simply don’t have the resources needed for adequate surveillance, and even the richer Southeast Asian countries like China, as described by a senior fellow for Global Health at the Council on Foreign Relations,2147 are “completely lacking in sophisticated public health infrastructure.”2148

When bird flu first emerged in Vietnam, for example, the country’s leading analytical center—the National Institute of Hygiene and Epidemiology in Hanoi—had no safety cabinets, freezers, centrifuges, or incubators, and had to turn to the WHO for a loan. Simple blood tests had to be shipped out of countries for results.2149 “We did not even have masks and gloves,” said one virologist at the Institute.2150 Some countries like Laos had never had a virology lab at all.2151

The World Health Organization, the World Organization for Animal Health, and the Food and Agriculture Organization of the United Nations came together in 2005 to put out an international plea for funds to help control the disease in poultry populations and detect the disease in human populations. They called for a minimum of $100 million.2152 “Countries in Asia are doing their best to control the virus but they cannot and should not be expected to do this job on their own,” said the FAO’s chief veterinary officer.2153 “The coming influenza pandemic will cut huge swathes in the world community,” professor John Oxford warned, “and history will look back with a jaundiced eye should governments hesitate and not join in this war, and place monetary priorities elsewhere.”2154

Said top FAO official Samuel Jutzi, “There is an increasing risk of avian influenza spread that no poultry-keeping country can afford to ignore.”2155 Worse than ignoring, countries have actively covered it up. Even if countries could afford proper facilities, many Asian countries have admitted concealing outbreaks, in part, to protect poultry industry interests. “An obvious major weak spot in global surveillance,” the director of the Australian National Centre for Epidemiology and Population Health points out, “is the tendency of national governments to deny or suppress information.”2156 Thailand presents a good case study.2157