Thursday, September 22, 2005

International epidemiologists and officials of a growing number of countries are concerned that bird flu could mutate into a virulent form of human flu that could kill millions across the globe. They urge a united international front to defend against it.

“It’s coming,” says Dr. Lee Jong-wook, director-general of the World Health Organization (WHO), who urges intensified planning now. “When the pandemic starts, it will simply be too late.”

The latest avian-flu strain, blamed by WHO for 63 deaths in Vietnam, Thailand, Cambodia and Indonesia, has spread to poultry in Russia and Kazakhstan and will almost certainly show up in Western Europe as well, international health specialists predict. Tens of millions of birds, mostly chickens and ducks, have been slaughtered in Asia to prevent spread of the animal strain.

WHO researchers say between 7 million and 100 million humans worldwide could die in such an outbreak. Dr. Michael Osterholm, head of the University of Minnesota’s Center for Infectious Disease Research and Policy, predicts it could kill at least 1.7 million Americans. Worldwide, he foresees at least 180 million deaths and possibly 300 million.

But the operative word is “could.” The disease must first mutate into a strain to affect humans; flu virus mutates with ease, and it could mutate into a killer strain — or into a relatively harmless strain. Some analysts describe Dr. Osterholm’s forecasts as far-fetched, given that only 675,000 Americans died in the 1918 Spanish flu epidemic, when medicine was relatively primitive and between 20 million and 50 million people died worldwide. About 40,000 Americans, mostly the elderly, die of flu in an average year.

“This could be a false alarm,” one researcher says. “But false or not, alarm is certainly appropriate.”

President Bush announced a new “international partnership” to prepare for an epidemic, if not a pandemic, in his Sept. 14 address to the United Nations. “If left unchallenged,” he said, “[avian flu] could become the first pandemic of the 21st century. We must not allow this to happen.”

The president raised his concerns in a private meeting in New York with Chinese President Hu Jintao. Chinese public health officials were sharply criticized for their slow and secretive response in the early days of the SARS outbreak in 2002. The U.S. will host a meeting in Washington of partnership members within the month to prepare for a human bird-flu pandemic. Canada will host a similar meeting of senior health ministers from 30 nations by the end of November.

The alliance is meant to improve information-sharing; coordinate donor funding; and build up public infrastructure in targeted countries, many of which are too poor to finance their own major containment programs. Indonesia, for example, has been reluctant to kill flocks of suspect birds because it does not have the money to compensate farmers.

Nearly all of the humans who have died of avian-flu infection in Asia had direct contact with infected birds. An epidemic or pandemic could occur if the virus mutates into a strain that would spread by casual human-to-human contact.

The Indonesian government, accused of responding slowly to the threat, yesterday fired its chief of animal-health control for failing to check the disease among domestic fowl. The government assigned 44 state-owned hospitals the task of treating human avian-flu patients, and said it might order anyone with flu symptoms — coughing, high fever and difficulty breathing — to hospitals.

That action came as Indonesian officials worried they were possibly confronting a rapid human outbreak in that country, since as many as six persons may have died of the infection since July. Two young girls, ages 5 and 2, who had avian-flu symptoms, died yesterday. Nine other patients suspected of having the bird-flu virus were being treated at a hospital in Jakarta, Indonesia.

Infection is “just a plane ride away,” says Dr. Lee of the World Health Organization. “In this interconnected world, no part of the world is safe.”

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