H5N1 = Y2K ?!

While looking for progressive gear, I found this store. Its connection to things progressive seemed tenuous at best, and unfortunately to be a twig of "alternative science" that isn't really progressive itself, but whose adherents often seem both to be of a neo-naturalistic persuasion and to have progressive convictions.

So, anyhoo, I surfed to the site to which the shopkeeper contributes, and posted the following comment in reply to his most recent "bird 'flu is fearmongering" post. I think it's decent, so here y' be:

I came to this post (and your other bird 'flu ones) by way of your Bird Flu Panic shop, which I found while browsing Irregular Goods for buttons and stickers.

First, my quals: I have a Ph.D. in archaeology, I think evolution is a far better explanation than creation, and it's just as well that I was brought up in the Episcopal Church because I'm basically an agnostic with a sentimental attachment to the Christian tradition. I also work (as a non-profit version of a graduate assistant) in an office full of biologists.

All of that said, I am puzzled by your apparent dismissiveness of the potential H5N1 threat.

Now, granted: H5N1 is not epidemic in humans; it is not, so far as is known, easily transmitted from non-humans to humans, nor from humans to humans (which seems to be why it is not epidemic).

On the other hand, the mortality among humans who do contract it is fairly high. And although mutations that improve the transmissibility of a 'flu virus usually also reduce its virulence, this is not always the case, as is known all-too-well from the 1916 Spanish 'flu. I do not understand the details, but the genetic similarities between the 1916 virus and H5N1 are such that, with the right mutations, H5N1 could turn 1916 on us. And the 1916 strain was unusually virulent: it killed quickly, and, for reasons that remain unclear, it preferentially infected healthy adults (the people most likely to be out & about in public) rather than the very young, old, or infirm. *That* is why epidemiologists in the U.S. are nervous and epidemiologists in SE Asia are downright scared (many no longer eat poultry).

Of course, there is no guarantee that the necessary mutations will ever occur. But H5N1 is a bit different from Y2K in that there was a deadline for Y2K. There is no deadline for H5N1. For all we know, it will never become epidemic. But there is no way of knowing that. We can't even say when a time will come that that danger will have passed.

Part of the concern is also the logistics of 'flu control. It takes about 9 months to get a 'flu vaccine into distribution. (Yes, this means that each winter's 'flu shot was developed the previous spring, meaning that they are based on *educated guesses* about what 3 strains seemed likely to be most prevalent the following winter.) What with air travel and public transit (of which I am a great fan, and use every day), a virulent strain could be spread almost as quickly as news of its emergence, meaning that containment would be nearly impossible, and vaccination virtually impossible.

Moreover, there is not enough 'flu-vaccine production capacity in the world to protect BOTH people at an outbreak location AND citizens of the countries with the vaccine production facilities. There is not, in fact, enough production capacity even to vaccinate every citizen in vaccine-capable countries. So guess who stands to miss out? The countries with the greatest likelihood of an outbreak, of course: which, because of the ease of travel, are also the best places for trying to contain any such outbreaks. Indonesia has stopped providing samples of H5N1 to the World Health Organization (which samples are essential for keeping tabs on H5N1 evolution) until it gets a legally binding agreement that its samples will not be used to make an expensive vaccine.

Then, of course, there is the cost. The politicians are reluctant to spend money on a threat that may never develop. But if they wait until it does, it will be too late.

There are other considerations, too, about which I am poorly informed, such as the degree to which Tamiflu (for example) can reduce the intensity of bird 'flu one contracted, and Tamiflu supply logistics. (I do know that Tamiflu won't be a panacea, but I don't know the details.)

I will grant that much of this information isn't to be found in the mainstream media. But from what I've seen, it's not so much that the media's coverage has been incorrect as that it has been (vastly) incomplete. And, yes, none of the small outbreaks of bird 'flu has developed into anything of international significance. Still, news of clusters of bird 'flu deaths makes epidemiologists anxious because that's how "the" outbreak is likely to begin. Epidemiologists don't see these small outbreaks as overhyped blips -- they see them as bullets dodged.

The summary, I suppose, is this: H5N1 probably won't evolve 1916-like virulence. But, unlike most 'flu strains, it *could.* And if we wait until it *does,* there will be very little that we can do to control it. And that would likely have have worldwide health & economic consequences far outweighing the not-trivial costs of preparing for a threat that never materializes.

So, after all of this, I guess my question is: do you really think that H5N1 is just media fearmongering, and if so, why? Because I really do not understand.