As of June 6 13, 2006, there have been 225 cases of avian flu (H5N1) reported to the World Health Organization (WHO), with 128 deaths.  If a pandemic was due to this virus, the mortality rate would be expected (or hoped?) to be much lower.  The 1918 pandemic (avian flu of similar genetic makeup) had a mortality rate of 1-2%.  Less sophisticated healthcare, including lack of antibiotics, probably contributed to many of the deaths.  Confirmed cases of Avian Flu:  Confirmed Case Reports

This influenza is spread among birds, both domesticated and migratory species.  Outbreaks in birds have been reported in many countries.  For up-to-date information on the outbreaks in birds:  Animal Influenza Updates

Cases occur almost equally in the age groups from 0-39 years.  The virus may remain infective on surfaces for up to 48 hours.  The incubation time may be 2-3 days and the initial symptoms characteristic of other flu infections.  However, it rapidly progresses to acute respiratory infections.  People with strong immune systems may be particularly at risk. This is due to the very strong and aggressive reaction of the immune system to an overwhelming infection.  The immune response can cause inflammation deep in the lungs, causing even more respiratory damage. 

Most cases are from human contact with infected poultry.  There are cases of suspected human-to-human transmission.  These cases of human-to-human transmission is of concern.  Of more concern are people infected, but asymptomatic.  These people are carriers of the virus and offer an environment where genetic mutations with human virus' may be promoted. 

The H5N1 virus is of particular concern because it mutates rapidly and a propensity to acquire genes from viruses infecting other species (which make transmission to human more likely).  Strains of H5N1 circulating in Viet Nam are possibly becoming more infectious for people.  Development of a vaccine for a newly mutated form could take up to four months using common manufacturing techniques.  Tamiflu, a widely touted antiviral drug, has been of concern to researchers lately.  It appears that the flu virus may develop resistance to the drug when given in too low of doses. The dose required for protection from the flu may have to be adjusted upward (Alicia Change, Associated Press - Denver Post, December 22, 2005). 

WHO has prepared a Global Influenza Preparedness Plan (2005)  and a Influenza Pandemic Preparedness Checklist (2004) available on their website.  The US Government has read these documents (thankfully).  It is most interesting the discussions of the potential need to abandon civil rights, take private property, compulsory vaccinations, use of non-approved drugs, and emergency legislation.  These issues were highlighted by President Bush when he referred to using the military to enforce quarantines (though existing laws would have to be modified).  A scary prospect, but one that may be necessary.  If (when) it happens, I hope we can trust the people that are in the Executive Branch at that time.  We have to be careful and specific as to the limits of authority we delegate to our military. 

To manufacture a vaccine would cost $2 billion dollars or more.  Pharmaceutical companies are not excited about producing vaccine until they are assured a market.  Can we afford to wait?  Is the investment significant compared to the money expended in Iraq on a daily basis? 

One issue that is always of concern is the lack of reporting in less developed countries.  Governments, for political, economic or technological reasons, may not report cases of suspected avian flu, allowing the virus to spread in the event it becomes human-to-human transmissible.  In addition, many areas do not have adequate testing facilities to confirm suspect cases, delaying a potential early warning by days.

Please obtain current information on the WHO website.  Stay informed. 

There is little doubt that if the bird flu mutates to develop airborne transmissibility and has a significant mortality (2-5%) substantial worldwide impacts will be experienced.  These will last for a period of many weeks (20 or more) and the pandemic may reoccur.

If controls measures fail to contain an outbreak:

1.  Travel/Trade curtailed with affected country.  Major impacts on world stock markets.  Best advice:  Get your investments in a very conservative fund (not tied to the stock market) before trading is suspended.

2.  Business/Jobs:  Many businesses will close.  Businesses should develop a plan to continue to function during a pandemic.  This includes telecommuting for employees where it works.  Personal hygiene surveillance for workers that come into the office.  This includes monitoring for illness and dedicated decontamination practices throughout work day for doors, surfaces of elevators, and work areas, etc.  In some cases, employers may be wise to consider extended work schedules (one week on, one off) where possible to minimize external contact.

More stores would be doing drive though groceries to keep infected people out of the store.  Disinfection of money and credit cards would be essential.  Retail businesses should develop plans to do drive through business, taking orders outside to customers, and curbside deliveries. 

3.  Utilities:  It is likely that as the pandemic becomes entrenched, utilities may become affected.  Electricity, phone service and fuel oil transport may be particularly vulnerable due to the significant amount of employee contact necessary.  If the pandemic occurs during winter months, this could be particularly problematic.  Of particular concern would be the inability to get fresh, clean drinking water should water supplies be affected.

4.  Health Care:  Overloaded.  If the US experienced up to 2 million deaths (and tens of millions of Americans with symptoms), the medical community would be quickly overwhelmed.  Because the government is investing so little in vaccine development and production, most Americans will not have access to vaccines. 

5.  The Katrina Effect and the Government:  Speaks for itself.  The government will not be posed to do much for anyone.  Postal service may be adversely affected.  Postal carriers will not be immune to the virus.  Transmission via handled mail may be of concern (decontaminate prior to handling).

6.  Communications:  As long as there is electricity, this may not be a problem (with getting information) via the Internet, radio, and TV.  If electricity fails, then if the homeowner has not generator or means to charge a cell phone or run a radio or get TV reception, they may be cut off.  See info on what you need to plan for below.  This is probably the most important aspect of ensuring people do not panic and know what to do.  While the government planning and resource commitment is unbelievably bad, the only place that the government generally excels in its poor performance is when it has to convey accurate and timely facts and information to the public.  

7.  Food:  Most grocery stores will be closed or operating only a few hours per day.  This would be due to infected employees in some areas, infected customers, and lack of production and transport of food supplies. 

8.  Crime:  Of course, if the pandemic was devastating, riots and civil unrest would occur.  The military and police would be unable to contain this.  If you live in an unincorporated area, you may well be the law. 

9.  Government Intervention:   Laws taking away civil liberties would be needed to control people (curfew/travel restrictions) and allow the government to seize property to carry out its business would be passed.  There is already talk of enacting new laws and modifying existing ones to address some of these needs in the event of a severe pandemic.  Quarantines, off-license use of drugs, mandatory vaccinations, and compulsory service for emergency workers.

10.  Public Venues/Transportation:  Gone.  Shut down.  If the government (local) has any common sense, this will happen very early.  Movie theatres:  shut down.  Concerts:  shut down.  Sporting events:  shut down.  Anywhere that large numbers of people would be gathered for non-essential purposes may be prohibited. 

What can you do to prepare?      Plan and Prepare.  Do not rely on the Government.

1.  Start determining how you could live in your home for six months.  What supplies will it take?  Summer vs. winter.    Checklist being developed. 

2.  Protecting Family:  Travel restrictions - voluntary.  School.  Stir crazy.

3.  Protecting neighborhood:  If it gets bad, the community will need to police itself and assure local resources remain to support the local community.

4.  Surviving excursions into infected areas for food, fuel, jobs, etc.