H5N1 Pandemic Context
Today’s The New York Times has a level-headed analysis by writer Denise Grady of the risk (will it happen, and if “yes,” how bad and when) of an avian flu (H5N1 virus) pandemic that may kill millions.
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Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said a bird flu pandemic was unlikely this year.
“How unlikely, I can’t quantitate it,” Dr. Fauci said. But, he added, “You must prepare for the worst-case scenario. To do anything less would be irresponsible.”
Dr. Jeffery Taubenberger, chief of the molecular pathology department at the Armed Forces Institute of Pathology, said, “I would not say it’s imminent or inevitable.” Dr. Taubenberger said he believes that there will eventually be a pandemic, but that whether it will be bird flu or another type, no one can say.
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“Most bird flus emerge briefly and are relatively localized,” said Dr. Andrew T. Pavia, chief of the division of pediatric infectious diseases at the University of Utah and chairman of the pandemic influenza task force of the Infectious Diseases Society of America. The most worrisome thing about H5N1, Dr. Pavia said, is that it has not gone away.
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“It killed tigers at the Bangkok zoo, which is quite remarkable because flu is not traditionally a big problem for cats,” Dr. Pavia said.
It has also infected pigs, which in the past have been a vehicle to carry viruses from birds to humans.
“We should be worried but not panicked,” Dr. Pavia said.
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Dr. Bruce Gellin, director of the National Vaccine Program Office, said: “You get this sense of compounding risks. First, it’s in some birds. Then more. Then more area, then more mammals and then to humans, albeit inefficiently.”
In just a few instances, Dr. Gellin noted, the virus does appear to have spread from person to person.
“The only thing it hasn’t done is to become an efficient transmitter among humans,” he said. “It’s done all the other things that are steps toward becoming a pandemic virus.”
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The fear “is very much overdone, in my opinion,” said Dr. Edwin Kilbourne, an emeritus professor of immunology at New York Medical College, who has treated flu patients since the 1957 pandemic and has studied the 1918 flu.
The bird flu, he said, is distantly related to earlier flus, and humans have already been exposed to them, providing some resistance.
Scientists also say that the death rate may not be as high as it appears, because some milder cases may not have been reported.
Dr. Kilbourne and other experts also noted that when viruses become more transmissible, they almost always become less lethal. Viruses that let their hosts stay alive and pass the disease on to others, he explained, have a better chance of spreading than do strains that kill off their hosts quickly.