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Expert Offers Bird-Flu Insight: Medical Community Unprepared to Handle a Pandemic, Man Says

Posted on: Thursday, 20 April 2006, 09:01 CDT

By Tracy Wheeler, The Akron Beacon Journal, Ohio

Apr. 20--CLEVELAND -- A worldwide influenza outbreak will happen. Millions -- maybe even hundreds of millions -- of people will die.

But that's about all Michael Osterholm, an international flu expert, could say with certainty in a speech at Case Western Reserve University on Wednesday evening.

Will the pandemic grow from the H5N1 flu strain circulating in birds across the globe? Maybe, maybe not.

Will avian influenza spread to birds in North America this summer? Maybe, maybe not.

When the pandemic strikes, will it be as deadly as the 1918-19 pandemic that killed 50 million to 100 million worldwide? Again, maybe, maybe not.

"Influenza pandemics are like earthquakes, hurricanes or tsunamis -- they've happened before, and they will happen again," said Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. He has written about avian flu for the New England Journal of Medicine and talked about it on The Oprah Winfrey Show.

He has also earned the title of "a consistent voice of doom" from the St. Paul Pioneer Press.

Osterhold acknowledged as much at the beginning of his talk Wednesday, saying "elements of this presentation will make you want to find the nearest bar."

In June, Osterholm was quoted in U.S. News & World Report as saying that if the pandemic hit today, "I don't know what we could do about it except say, 'We're screwed.' "

Not much has changed since June. Plans to deal with such a public health crisis are lacking, if they're in place at all. "Hope and despair are not strategies," he said. "Comprehensive and serious planning is not optional."

The medical community can't even do a decent job of handling annual flu epidemics, which infect 5 percent to 20 percent of the population and kill 36,000 on average each year, he said, so how could it handle a pandemic? "For that," he said, "we are ill prepared."

The World Health Organization counts 196 human cases of avian flu, with 110 deaths. The first two months of this year saw more human cases (52) than did any six-month period in the past three years.

There has been no continued human-to-human transmission of the disease, but the fear is that the flu virus infecting birds will mutate, allowing human-to-human spread, sparking a pandemic.

That could happen in one of two ways, Osterholm said.

One possibility is known as reassortment, in which the avian virus mixes with a human virus and swaps genes, making a hybrid virus of sorts.

However, he said, "if it hasn't done it by now, I don't know why it would happen in the future."

The other possibility is a mutation of the avian virus in which it retains its avian characteristics but attains the ability to infect humans.

That, he said, "scares the devil out of me" because the human immune system would offer no protection against an avian virus, making it extremely deadly.

Or neither could happen. The virus could remain in birds and burn itself out.

"We don't know," he said.

What's also scary, Osterholm said, is that out of thousands of flu viruses, only two had a particular "protein tag" in their genetic code: the H5N1 avian flu virus, and the virus that caused millions of deaths in 1918-19.

What that means, of course, is still not clear.

"It's still moving. It's still floating. It's still changing."

Tracy Wheeler can be reached at 330-996-3721 or tawheeler@thebeaconjournal.com.

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Copyright (c) 2006, The Akron Beacon Journal, Ohio

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Source: Akron Beacon Journal (Akron, Ohio)

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