Do you have your paranoia ready?
More and more I'm hearing about people stockpiling water and tuna in an effort to outlast the 6-18 months of projected vital service interruptions that might happen should we have another flu pandemic. This could be due to the nature of website I visit and people I talk to and a general sense of distrust about everything at the moment. It could also be put down to blatant fear mongering from the media and some scientists hoping to cash in as well as government officials who have a vested interest in hyping the H5N1 virus as the Next Big Thing. For example, did you know that Rumsfeld holds between $5 and $25 million in biopharmaceutical producers Gilead Science. He even served as the Research Chairman prior between 1997 and 2001, when he joined BushCo. This is interesting because Gilead Science holds the production rights on Tamiflu, the leading influenza-treatment drug. While fears of an avian flu pandemic have sent Gilead's stocks on a rocket rise from $35/share to $47/share,
Rumsfeld has quietly raked it in.
Okay, now, I'm not suggesting that Rumsfeld is necessarily creating panic in order to boost his stock's value. However, he and the rest of the administration are doing very little to rationally address a possible flu pandemic or assert rational science into the process of preparedness.
There are a couple of reasons I'm not hugely worried at this point about H5N1 and the lastest cluster outbreak in Indonesia.
1. H5N1 is currently it's own worst enemy. The virus, for an influenza virus, kills quickly if it kills. In order for a virus to work it's way through a population, it must effectively spread beyond it's inital host before it stops that host's ability to spread it. If you're dead, you're not going to be going places where you can infect others. Thus, at the moment, H5N1 is its own best limiting agent, by taking infected individuals down very quickly, thus making it hard for a H2H transmissable variant of H5N1 to reach a large population area. Now, this could change. One of the viral development theories put forth is that, as the virus undergoes further iterations of it's structure (generations), the genetic change in a generation that would provide the virus with easy H2H transmission would also attenuate the virus, making it not so deadly or more easily treatable. While there is some speculation that this is, in fact, not happening, it is still a possibility as easy H2H transmission mutations still have not occured. Furthermore, the worst case scenario would be that the killer generation would possess all the lethality of the prime generation, but would take longer to present symptoms and kill the host, thus increasing the chances of a carrier coming into contact with a fertile host pool and triggering a pandemic.
2.
Clusters are, at the moment, found in family environments. Currently, people who come into contact with body fluids of infected poultry and birds are at risk for developing H5N1 flu. However, clusters of infections have been limited to families. A cluster of infection is important because it may represent a generation of H5N1 that can easily pass between humans. However, the confinement of possible H2H transmissions to immediate families is important. There is a compelling theory that a certain portion of humans are subsceptible to this particular flu strain because of genetic predisposition. This would, for the moment, certainly preclude this from being a true pandemic. Clutering has noted that family units tend to show a pattern of blood relative infection, meaning that a father and the children are infected, while the mother isn't, or vice versa. This argues strongly for a genetic determinate coming into play at some point in the infection process, although is not by any means proof. Furthermore, the fact that cases remain isolated gives more support to the idea that only a subset of world population can be infected by this strain, as it is now, because they have the genetic trait required. Now, current situations don't necessarily rule out future behavior. While the virus may currently be tied to a genetic trait, mutation or genetic hybridization with other flu strains may remove that component of infection, thus opening a gateway for a true pandemic. It is also little comfort to people who possess the genetic marker that makes the subsceptible to H5N1. Finally, while this is a compelling argument, it is by no means assured. The family grouping clusters could be due to shared exposure to an infectious agent, such as a chicken or a person who has become ill (it is possible currently to transmit H5N1 from person to person, it is just very difficult to do) and that could be the limiting factor, rather than genetic makeup.
3. Again, H5N1 works against itself in it's pathology. Currently, H5N1 resides very low in the lungs when it infects a host. Death from H5N1 occurs not beacause of the virus itself, exactly, but from the body's own auto-immune system basically drowning the infected person in blood and mucus in the lungs in an attempt to flush out the H5N1 virus. It's deadly pathology, however, works against it's easy spread. It's prime infection site makes it hard for it to get out of an infected host. H2H transmission must currently happen the same way as avian to human transmission: direct contact with infectious bodily liquids, preferably blood and mucus. For the virus to be a true pandemic threat, it needs to obtain a more readily dispersable infection mechanism. Just coughing or breathing is not enough to cause infection.
So while the latest cluter in Indonesia is interesting in the sense it comprises the larges family cluster seen to date, it is not exactly the clarion call of doom that the media are making it out to be. WHO has wisely decided that this incident should be looked at closely, but it does not necessitate an increase in the pandemic threat level. Ultimately, from what I know at the moment, the only difference in this cluster is it's size in comparisson to other clusters, not it methodology. If it was an entire village rather than one extended family that, I believe, shares the same family tree branch, it would be cause for more worry. Even then, though, depending on the relative isolation/remoteness of the area, genetics may still be the determining factor because more isolated areas experience more common genetic traits due to a certain level of inbreeding.
At the moment, I'm far more worried about Bush giving Negroponte the power to keep government contractor assets on the downlow.
