BIRD FLU
Are you scared by what you have heard about “Bird Flu”?
Well, you should be.
But you need to understand what the Bird Flu scare is all about, so that you can decide which bits to worry about.

There is one very important fact that you need to understand.
Sadly, it is a fact that is not adequately explained by the media:
THERE ARE 3 DIFFERENT TYPES OF BIRD FLU. (Yes, 3)

It is important to understand what these 3 types are:

There, not too difficult is it?

But every media broadcast that I have heard so far has talked generally about “Bird Flu” without making much attempt to distinguish between theses 3 types.
The result is that they have scared a lot of people when it hasn't been necessary.
Even worse, people are going to be fed up and bored with scare stories if it does ever become necessary to warn them that something really nasty is going to happen.

UNDERSTAND FLU
Many of the illnesses that afflict the human race can also infect other animals.
Sometimes, our illnesses are shared by dozens of other species.
And that is the case with Influenza, or “Flu”.
Flu affects ducks, geese, chicken, cats and pigs as well as humans.
And therein lies the problem…

You see, viruses like the Flu virus change very rapidly.
They constantly mutate to try to find a way to avoid the defences of our immune system.
All the time, there are new strains of Flu arising as the viruses change their characteristics and test out different species to infect, or different ways to spread.
Every time that a significantly new strain arises that can affect humans, we have an epidemic that spreads very quickly because no-one has any immunity to it.

What has happened in recent years is that a new strain has developed in ducks and other wildfowl…
Because it evolved in birds, it is known as “Bird Flu”.
It is a type known as H5N1 that hasn't affected humans for nearly 100 years – so none of us are going to have any immunity to it if it starts to infect people.
So far, it has mostly just caused sickness in birds,
The real concern is that it will find a way to pass from people to people…

UNDERSTAND THE 3 DIFFERENT TYPES OF BIRD FLU

THINGS YOU DON'T NEED TO BE SCARED ABOUT
Hopefully the summary above should put your mind at rest that there isn't currently any great public health scare that you need to lose sleep about.

The type of Bird Flu that is spreading around the world infecting birds is a great concern to farmers, like any other disease that affects our livestock. Many wild birds and a lot of domestic poultry will be made ill by the virus, and many will die. Many more birds will die as they are killed in any attempts to slow the spread of the disease. But however badly the virus affects birds, that does not mean that there is any danger to people.

The type of Bird Flu that occasionally jumps from a sick bird to a person is still quite rare. Around the world, less than 100 people have died from such an H5N1 infection in recent years. The only people to be infected have been agricultural workers in close contact with sick birds, or those involved in the culling of sick birds. The small numbers of infected people that have died have mostly been in poor countries, and/or poor rural communities, where they have not received the best of modern medical care. And most important, no person infected with H5N1 has ever been shown to have infected another person. Even where several members of a family or community have become infected, it seems they all caught the infection from the birds, and never passed it between themselves.

For this reason, we can be confident that a strain of H5N1 that could pass between people and cause an epidemic has not yet evolved. It may happen in the future, but it hasn't happened yet. That is why the current scare stories in the media are irresponsible – because they are talking of the current infection in birds as though it is something that represents a threat to people – and it doesn't.

THINGS YOU DO NEED TO BE SCARED ABOUT

The one great worry amongst health officials is that a new strain of H5N1 will evolve that can easily pass between people. That would cause an epidemic.
Because we already know that none of us has any significant immunity to H5N1, we know that if it gains the ability to spread between us any epidemic would be a bad one.

Every 10 or 20 years a flu epidemic affects us, and every time is different.
Each strain is different in the speed with which it spreads, and how badly it affects us.
But in recent years we have become a little blasé about flu!
As we have all become better fed and fitter and healthier, we have come to regard flu as a nuisance that might need a few days off work, but which has a serious effect only on those who already sick from other causes, or those who are very young or very old.
This time it could be different…

Because H5N1 hasn't done the rounds for so long, none of us has any immunity – so it could affect us all very badly. How badly? Well, it could be very badly indeed…

WHEN WILL THIS HAPPEN?
Honest answer – we don't know.
Will it definitely happen? Yes, probably. Almost certainly.

You see, what we have to worry about is that just one of all the countless H5N1 viruses that are currently infecting birds will make a change that makes it easy for it to infect a person – and that a person then gets infected and passes it on.
We can't be certain if and when that will happen.
However, because of the enormous numbers of viruses infecting millions and millions of birds, and because of their capacity to vary themselves so quickly, we have to assume that it will definitely happen sometime…

WHERE WILL THIS HAPPEN?
An epidemic would have to start because a suitable virus had passed from an infected bird to a person - and that the newly infected person had incubated the new strain, developed an illness, then passed it on to other people.
For this reason, it is most likely that it will happen in countries where poor people traditionally live in close contact with poultry. This means Asia or Africa.
Statistically it could happen anywhere – but it is unlikely to happen in Western countries where people now live separately from their livestock.

Even with workers involved in culling unhealthy birds, their good initial health, use of protective clothing and disinfectants, and modern healthcare, should reduce the chances that any suitable virus survives to start a chain of infection in people.
In Third World countries, the proximity of poultry and people, and their lack of protection and healthcare, means that it is the place where transmission of new varieties of H5N1 will occur between birds and people.

So it is only if (or when) you hear news reports of a new flu epidemic passing H5N1 from person to person that you need to worry…

HOW BAD WILL IT BE?
Again, we just don't know.
Flu viruses constantly change themselves in several different ways in order to get under our guard and avoid our immune system.
Until the mutation occurs that allows an H5N1 virus to become infectious between people, we won't know what other specific characteristics it has…
Will it pass slowly between people by touch, or will it be able to pass between us in the air – just one sneeze infecting a roomful of other people?
How badly will it affect us – just a few days of high temperature and feeling bad, or will it kill a lot of people really quickly?

We can't know these things in advance.
We have to wait for them to happen…
What we do know, is that the last time that a strain of H5N1 appeared for which the population of the world had little immunity was in 1918 – and what was then called “Spanish Flu” was devastating.

That epidemic was famous because of some unusual characteristics:

One true story that illustrates how terrible that epidemic was comes from the US.
Four ladies met up one evening to play cards. All four felt well. They felt well when they said goodnight. But three of them didn't wake up in the morning…

That epidemic is estimated to have infected 98% of the world's population, and 28% of them fell ill. And 3% of them died. That means over 40 million people died – more than 1% of the population of the planet.

There is absolutely no reason to assume that it will be better this time!

WHAT?
That's right, it could be horrific.

We have forgotten how bad flu can be, because recent epidemics haven't affected us too badly in the West…
However, flu is a very successful virus. Every year most of us are exposed to it because it gets around so easily. Every year it kills millions of people. Mostly it kills of the poor and the sick, so people in the West who are well-fed and healthy survive it and develop a level of immunity.

Even recent pandemics have been strains to which we had some immunity – such as Hong Kong flu of 1968 or the Asian flu of 1957 – so they weren't too bad for us.
But if the next pandemic is caused by H5N1 we are least likely to have any immunity and the result could be carnage.

If the next people-to-people strain has the same lethality as the 1918 strain, then the World could suffer 60 million deaths. But this time they could be here in the West and not in some distant place on the news…
And we are not used to it…

A lethality of 1% would mean over half a million deaths in the UK.
Over 2 million in the USA.

We are not used to that level of misery and suffering and loss in these countries…
Even worse, some communities would suffer disproportionately, with some having casualty rates of 25% or more… Like in the US in 1919, everyone in those places would have lost someone.

Neither are we used to such a high level of social disruption.
In the US in 1918, bodies went unburied because they couldn't make coffins fast enough.

We live in a tightly integrated consumer society where we expect fresh food to move from farm to supermarket shelf in hours. We expect the lights to go on when we need them. We expect radio and TV to keep us updated.
But if there was 25% of the population at home in bed – all fearing that they might be one of the 500,000 scheduled to die – how many would go to work?
Would you?

WHAT CAN WE DO?
This is the section where you hope to read about useful drugs, vaccines, or sensible precautions that you can take… Sorry. It isn't like that.

There is no vaccine yet for the strain of H5N1 that will cause the next pandemic.
It is only after a disease has surfaced that it is possible to isolate the virus and start to develop a vaccine. After that it takes months to build up a significant amount of stock.
The next strain hasn't evolved yet, so we have no vaccine.

Unfortunately, because the next pandemic could hurtle around the world in days, that leaves us very vulnerable…

We do have some small stocks of a vaccine against the strain of H5N1 that is around and affecting birds at the moment, but we just cannot guess at how effective this might be against the next pandemic strain. Even if it is effective, the small stocks that exist will be reserved for the health-workers who we will need to man the hospitals. Oh, and the politicians as well, I expect…

(The vaccine used routinely as a flu jab for the elderly, diabetics etc will be completely ineffective at warding off any H5N1 epidemic.)

There is no drug that we know to be effective against the strain of H5N1 that will cause the next pandemic.
Of course there isn't – for the same reason that there isn't a vaccine yet.
An effective drug for any disease can only be developed and manufactured in bulk after the disease has been isolated and studied. Even then it usually takes years to bring a new, safe drug to market.
The next strain hasn't evolved yet, so we have no effective drugs.

Again, because the next pandemic could hurtle around the world in days, that leaves us very vulnerable…

What about Tamiflu? Well Tamiflu is a drug with very limited effectiveness – it can only help reduce the seriousness of the illness if treatment is started within 36 hours of infection. Preferably 6 – 12 hours. That's all there is.
If the next pandemic strain kills as quickly as it did in 1918, you may not live for 36 hours after infection…

And if 25% of the population is suffering, including 25% of the healthcare workers, how quickly will you get an appointment at your GP's surgery?
Besides which, stocks of Tamiflu are small and will inevitably be reserved for healthcare workers. Oh, and politicians as well, I expect…
(There is another anti-viral called Relenza – but the same doubts exist.)

SO WHAT ELSE CAN BE DONE?
Sadly, not a lot.
There are no quick fixes.
There are no wonder drugs.
No smart ideas.

New Scientist ran a special pull-out supplement on 7 th January 2006, called “The bird flu threat”. It concluded with a page entitled “How to protect yourself and your family”. It was depressing reading.

If a pandemic has started, then washing your hands frequently and avoiding other people is the best advice they could offer.
Isolating yourself (which was my big plan) could be difficult to achieve if there is a high level of social disruption lasting for several months – or even a couple of years.
And the virulence of the bug could also increase as time passes, so catching it early could be a blessing in disguise – or not.

Stocking up with antibiotics to help control secondary infections like pneumonia could help – but is actually more difficult in a country with drugs controlled by the NHS than somewhere where you can go out and buy them.

Their best advice was “become indispensable”. In this, they are referring to the fact that the limited stocks of vaccines and drugs that will be available will be reserved for emergency workers. Oh, and politicians, I expect.

SO IS THERE NOTHING ELSE TO BE DONE?
Well, to start with it would help to have a well-informed public debate on the subject.

Scare stories about sick birds have no relevance at all.
We need a debate about how we can cope when it becomes stories about sick people.
And we can't delay the debate until then because the speed at which it might spread will overtake any efforts that are delayed that long…
There is next to no planning to develop and manufacture new drugs or vaccines at the speed that will be necessary – or in the quantities that will be necessary.
It could be possible, but would require the sort of efficient planning usually only seen in war time.
That can only be co-ordinated by central government, yet the research and manufacturing facilities are all owned by industry (the pharmaceutical giants).
The pharmaceutical industry will not take the risk of starting up production of vaccines or drugs that might prove ineffective because of the cost.
Only central government has got the responsibility to take that gamble, and because none of them plan beyond the next budget that shows no signs of happening.

So, we just sit and wait…
Stories of sick birds are broadcast to scare us – without any point.
Stories of success culling sick birds will give us false hope.
We need a debate about the sick people that we all may become in the future…
Ask your doctor what plans he has to cope with a pandemic…
Ask your politicians what plans they have to cope with a pandemic…
And keep your fingers crossed…

WHAT HAPPENS NEXT?
Back in the 1980's we sleep-walked into the AIDS crisis.  It killed homosexuals and haemophiliacs here, but our society continues much as before.  Other, Third World countries, are having their populations ravaged by AIDS. We then sleep-walked into the BSE crisis.  Millions of cattle were slaughtered, and some lovely youngsters died of a ghastly "new variant CJD" while John Gummer force-fed his grand-daughter with beefburger.  But most of us survived, and we carry on much as before. 
We then sleep-walked into foot-and-mouth.  Again, millions of livestock were slaughtered - but we survived and carried on as before.

This one is a bit different.  This is a disease that is pointing squarely at us.
Our lack of immunity to H5N1 means that casualties in the West will possibly be much greater than in Asia.
And we are sleep-walking into it.

The speed with which this might happen will not allow us the luxury of further discussion, or being wise after the event. As I said recently to a friend of mine, think about how it will happen if it does mutate into a form that travels quickly by coughs and sneezes, and also becomes a strain with high lethality...
When there are the reports of possible human-to-human transmission from India or Vietnam or China, their local health officials will probably try to cover it up, or at least calm everyone down.  No-one will want to be the first to go on TV and shout "Panic!"
Everyone knows that to start a false alarm would attract massive criticism.  So in the time that it will take them to "confirm the bloody obvious", the virus will be getting on jet aeroplanes and flying around the world.
Or as I summarised: "Maybe you will go into town and see dead bodies on the street in Bromley before you get confirmation on the TV that the pandemic has started".

Is that an overstatement?  Am I scare-mongering?
Well, only time will tell...

If the next pandemic flu virus is H5N1 with the same speed of transmission and the same speed of kill as the 1918 strain, then I'm afraid that that is exactly what will happen.  Vaccines and Tamiflu and good health will make little difference.
(At latest count there were less than 20 million doses of Tamiflu in the OK.  Even if it only needed one dose per person, that means that two thirds of the 60 million population of the UK will get nothing.  And I think effective treatment needs more than one dose...)

Am I exaggerating the risk of an H5N1 pandemic?
Well the Government Chief Scientist, Liam Donaldson, said on Newsnight recently:  "It isn't a matter of if, but of when..."

The only question remaining is how bad will be the strain the evolves human-to-human transmission?
We cannot possibly know that until it happens...
But at the moment we are just sleep-walking towards what could be a catastrophe...

So can we do anything at all?

We knowing the facts is a start.
When they show you news items about sick chickens, know that isn't the real danger.
When they say the illness in birds has been contained, remember the real danger is still to come.
When they say we have drugs like Tamiflu, remember the benefits will be tiny.
When they say they are gearing up to produce a vaccine, know they will be six months too late.

Just knowing the facts will mean that they can't pull the wool over your eyes.

The advice we are being given now - or the lack of it - is similar to the the suggestion that you could survive a 20 megaton blast from a soviet H-bomb by painting your windows with whitewash.
It is almost as if the authorities have accepted that enormous casualties are unavoidable and are planning accordingly.

They will have kept back the Tamiflu and the general antibiotics for a list of "emergency workers" that will have themselves at the top, then the hospital staff and the military.  If you are not on that list, then you are just expected to be a casualty just as you were planned to be "collateral damage" if a nuclear war came along...

A lot of journalists got themselves in trouble for implying that the case for war in Iraq was "sexed up".
Where are the investigative journalists to ask why this enormous danger is being "sexed down"?

Realise how hopeless it sounds, and then decide what you can do.

Ask your GP or their Practice Nurse what is their policy regarding Bird Flu (the coming human-to-human variety).
They are charged with caring for your health, and you have a right to know.
You pay their salaries, so you have a right to ask...
You may be English, but you are still allowed to embarrass people!
If they say it unlikely that there will be a pandemic, remind them of what Liam Donaldson said.
If they say there will be a vaccine, point out that there is none.
If they say there will be drugs to help, ask them which ones?
Ask them if it is correct that there may be some Tamiflu for them, but that there certainly won't be any Tamiflu for you.

Your area also has a Consultant in Communicative Disease Control (CCDC) who is paid to have a policy on this sort of thing.
You also have a Community Health Council or somesuch that is required to help you get answers.
And you have a Member of Parliament who is paid to represent your best interests...

Ask them why there is no policy to stockpile and distribute antibiotics other than using the existing NHS system of prescriptions? One fact is that many deaths from infections like flu are caused not by the virus but by other infections that can then get into the damaged lungs (such as pneumonia) – we have antibiotics for conditions like this, but the demand is likely to exceed the system of waiting for a prescription from your GP then taking the piece of paper to Boots…
Why aren't the authorities planning for an emergency?

All these people are likely to be striving to get themselves on the priority list for treatment.
You really have a right to ask questions of them...
If you don't, you will really have no-one else to blame except yourself...

Chris Callaghan B.A. (Honours Biochemistry) February 2006

--------------------

Since writing this, I have been asked to say something a little more positive!

I have told it like it is, but I do agree that just scaring people isn't kind – I need to be able to suggest to individuals what they can do to help themselves to protect them and their families.
Personally, I do think that urging people to confront their doctors and their politicians is suggesting a positive action. You have to have some faith that it is possible to change things, and that you can do it!
However, we have also realised that there may be other things that you can do… But they do require that you do something for yourself. You need to take action, argue with people, look after yourself. Sitting on your arse and waiting for “them” to look after you is unlikely to be good enough…

Tip 1:
Some GPs are willing to write private prescriptions. This means that you will have to pay the going rate for drugs rather than having them subsidised by the NHS. But what to ask for?
If you believe that Tamiflu is worth having, ask for that.
A broadband antibiotic, or even one specific for pneumonia, would also be worth having in the medicine cabinet.

Tip2:
Several other countries in Europe also sell antibiotics over the counter. If you can afford to buy a ticket to go on holiday, you can afford a ticket to save your life, can't you? For under £100 you could fly off for the weekend and come back with enough antibiotics to save your life…

If you have any other suggestions to make, let us know.
If you have any general comments on this article, please let us know.
Simply click here to send us an email: help@SunbirdManagement.co.uk
(please enter “Bird Flu” as the subject of your email)

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