We are all gonna die - but not from bird flu

Wendy Orent, an anthropologist and author of "Plague: The Mysterious Past and Terrifying Future of the World's Most Dangerous Disease."... said public health officials have vastly exaggerated the potential danger of bird flu.

Several factors make it unlikely that bird flu will become a dangerous pandemic, Orent said: the virus, H5N1, is still several mutations away from being able to spread easily between people; and the virus generally attaches to the deepest part of the lungs, making it harder to transmit by coughing or breathing.

“We don’t have anything that makes us think this bug will go pandemic,” Orent said.
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Flu virologist Adolfo Garcia-Sastre, a microbiology professor at the Mount Sinai School of Medicine in New York, agrees that all the focus on H5N1 may be unhealthy. As part of the team of scientists who recreated the deadly 1918 flu strain, he's glad people are paying more attention to flu but thinks the level of worry is a bit too high. If this avian flu doesn't turn into a pandemic, he wonders, will all these new flu-fighting measures be tossed aside?

"Focusing only on H5N1 ... I think is a little bit shortsighted," Garcia-Sastre said.
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Public health officials always have to walk a fine line when sounding the alarm, said risk communications expert Peter Sandman, of Princeton, N.J., a consultant to the World Health Organization and the U.S. Department of Defense. Bird flu is a tough case because it’s both scary and unlikely. People see-saw between overreacting because the potential threat is horrific, and under-reacting because the threat is also unlikely.

“When you look at a risk that’s horrific but not likely, it’s hard to know how to think about it,” Sandman said.

Sandman said public health officials need to do a better job of communicating the uncertainty around bird flu — as Fauci seemed to be attempting this week.

“It’s unfair and dishonest to make it sound like we’re sure H5N1 is coming soon and it’s going to kill half the population,” Sandman said. “It’s equally irresponsible to say, because only a hundred people have died, it’s not a biggie. It’s potentially very scary, but potentially is only potentially.”

Mixed messages
Vocabulary is part of the problem, Sandman said. The term “bird flu” is used for the virus that is now killing birds — and has infected nearly 200 people who came into very close contact with birds. And it’s also being used to describe a mutated virus — which hasn’t yet emerged — that would spread easily among humans.

Sandman stressed that the current “bird flu” that kills birds is not the same as the potential “bird flu” that could cause a deadly pandemic.

“Chicken isn’t a problem,” he explained. “The big problem is the risk of mutation, at which point I’m at risk from the subway seat you sat on, or the doorknob you pulled open. After the mutation happens we should both be more afraid of doorknobs than chicken. Before the mutation, we shouldn’t be afraid of doorknobs or chickens.”

You can’t put a quantitative number on what the chance is that this H5N1 is going to be a catastrophe. The complexity of things for this to happen is multifaceted and very complex. [A pandemic] is not necessarily going to be caused by the H5N1 virus. H5N1 may not, in fact, go anywhere and just dead-end itself.

Researchers have suggested why the H5N1 bird flu virus has so far been inefficient at infecting people and unable to spread between them.

In papers published tomorrow (23 March) by Nature and Science, they say the virus may be physically unable to reach vulnerable cells deep inside human lungs.

Although H5N1 is very good at spreading through large populations of birds, it has infected fewer than 200 people since 2003.
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this week's findings show that the virus is rarely able to attach to cells in the upper respiratory tract.

What's more, it seems that mucus could be trapping the virus, which is then expelled before it can replicate, says Thijs Kuiken of the Erasmus Medical Centre in the Netherlands.

While H5N1 cannot enter cells close to the nose and mouth, both Kuiken's team and another led by Yoshihiro Kawaoka, of the University of Wisconsin-Madison in the United States, found cells deep inside the human lungs that the H5N1 virus can bind to — if it is able to get that far.

This fits neatly with observations made during autopsies of people killed by the virus: that most damage was deep in lung tissue...

While the spread of the H5N1 virus to Europe is a serious issue for farming and wildlife, it presents a negligible threat to human health that should not worry the public, Professor Sir David King told The Times.
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experience of the disease in Asian countries suggests that individuals are about seven times more likely to win the national lottery than they are to contract bird flu.

In China, where the disease is endemic among birds, just 14 infections and 8 deaths have been confirmed by the World Health Organisation in a population of 1.3 billion people — a rate of one case per 93 million and one death per 163 million.

This suggests that the current form of the virus is so difficult for humans to catch that the risk will remain extremely remote even if it infects British birds, as is likely now it has spread to France and Germany.

Britain’s population is 60 million, making even a single case unlikely at these odds.

Speaking exclusively to The Times, Sir David said that the public health threat from the virus had been widely exaggerated, and confused with the danger it posed to the poultry industry.

“It is very important to keep things in proportion, and to make a distinction between the virus in birds and the virus in humans,” he said.

“Your chances of winning the lottery are about 1 in 14 million. Your chances of catching bird flu are more like 1 in 100 million, even if we had H5N1 among the chicken population in Britain.

“That’s a back-of-the-envelope calculation based on China, but the real figure will not be much different. It may in fact be even lower than 1 in 100 million, because we don’t live cheek-by-jowl with chickens in the same way. Simply put, this is not an issue we should worry about in terms of public health.”
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From a human health point of view, he is more concerned about the spread of H5N1 into Africa, where cases have now been confirmed in birds in Egypt, Nigeria and Niger.

These developing countries lack the resources to contain the disease, and have backyard poultry flocks similar to those found in the Far East, which expose large numbers of people to the virus. This creates potential crucibles for genetic mutations that could allow the virus to start spreading from person to person, a critical event for a pandemic.
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His comments were backed by Neil Ferguson, Professor of Mathematical Biology at Imperial College, London, one of the world’s leading influenza epidemiologists. He said that the risk of human cases in Britain was “absolutely negligible”.

“There have been about 150 infections in South-East Asia and China, and the population size of the heavily affected region is around the 300 to 400 million mark,” Professor Ferguson said. “Whether it is 1 in 100 million or 1 in 10 million, it is a very small risk. ... The risk is absolutely negligible, though convincing people of that is difficult because H5N1 has now acquired a rather mythological status.”

Susanne Glasmacher, of the Robert Koch Institute in Berlin, which leads Germany’s bird flu containment efforts, would not estimate the risk of human infections in the country, where 136 dead birds and a cat carrying H5N1 have been found. Any risk, however, is likely to be lower than in Asia. “The virus in Asia was passed on overwhelmingly to poultry farmers and those living in very close daily contact with birds,” Dr Glasmacher said. “In Germany we have different lifestyles.”

Researchers and health agencies continue to sound the alarm about avian flu, and Dr. Gary Butcher, an expert on poultry medicine and disease at the University of Florida's College of Veterinary Medicine thinks he knows why.

"The agenda here is pretty obvious," he said. "People want grant money. This is a bonanza."

Butcher, who advises agricultural ministries and poultry companies around the world, is Florida's lone poultry veterinarian. He has also emerged as a leading naysayer on the prospects for a avian flu pandemic.

Butcher insists the likelihood that the H5N1 avian flu virus in Asia will trigger a pandemic is practically nil. But the fear-mongering will continue, he said, as long as people see a potential for financial and career gain in it.
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"This is a full-on war against agriculture," Butcher said - and he is firing back.
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"The threat is basically zero," he said. "We're spending all of our attention on this [virus], and another one may sneak up on us."
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The WHO's Web site also warns that the H5N1 avian flu has killed half of the people it has infected. That's true, Butcher said, but given the fact that the virus has only infected roughly 130 people, that 50 percent statistic paints a misleading picture. [note: this is of people known to have been infected; cf ideas many infected without much illness]

"The guy who wrote this really wants to make this sound like a big thing," Butcher said, reading through the WHO's "frequently asked questions" about avian flu.

"Dr. Butcher is certainly entitled to his opinion," WHO spokeswoman Maria Cheng said in an e-mailed response. "We clearly do not share it."
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The veterinarian reserved some of his harshest criticism for the USDA, which he believes is overstating the threat to justify its intensifying bird surveillance programs and gain funding and influence.

"They're trying to keep [avian flu] in the spotlight," he said.

"Everyone's keeping it in the spotlight," said Madelaine Fletcher, spokeswoman for the Animal and Plant Health Inspection Service division of the USDA.
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Butcher's perspective is not only that of an academic expert, but that of an industry consultant. When he is not teaching and researching in Gainesville, Butcher often travels to Panama, Russia, Ecuador, Vietnam, Thailand and other countries, advising governments and poultry companies whose survival and profits are threatened by public fears of bird flu.

In his travels, he said, he sees the evidence of serious economic harm caused by misplaced fear. "Poultry consumption is down 50 percent in Europe," he said. "It's a disaster."
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But Butcher remains troubled. "I don't think people understand the effect its had on economies, industries and even the mental health of people around the world," he said. "It's prudent to be prepared, but it's not prudent to inspire this overreaction."

The government's preparations for a possible outbreak of bird flu are being panned as being completely over the top.

This week the Ministry of Health began distributing leaflets explaining how New Zealanders should prepare for a possible pandemic.

It is already stockpiling shots of the ant-viral drug Tamiflu.

But Macquarie University professor Peter Curson, from Australia, said New Zealand is getting into a flap over nothing.

He said the government is reacting to something that is very unlikely to happen.

Peter Curson said the country would be better off declaring a pandemic of some the real health problems it has, like diabetes and obesity.