Scaring everybody witless

It seems to me that some international experts are rushing around like headless chickens and because they are panicking are issuing all kinds of statements, which are, frankly, not helpful.

The anxiety generated by the possibility, or certainty according to some, of a strain of avian flu, which caused the 1918 pandemic when a bird flu jumped to humans and killed at least 40 million people, being repeated has, not surprisingly, hit most of the world's headlines.

It is interesting that whereas it is usually the media who are accused of causing sensation in this kind of situation, it is now the international experts who are sounding the alarm, and perhaps causing unnecessary fear.

I say unnecessary for the simple reason that there is not much the public can do if the worst should occur. There is no vaccine against the avian flu virus. It can only be created in response to the virus being identified. So why scare everybody witless?

There are ways of raising awareness and letting the public know what they can do, but scaring them to death is hardly what we need right now. People might be rushing to get hold of vaccines when they do not need them.

This might in the long run do more harm than good, because the medication might run out and not reach the people who really need it, and public health officials also fear that overuse could lead to flu viruses becoming resistant to the drug.

CNN reported US Health and Human Services Secretary Michael Leavitt as saying that "the likelihood of a human flu pandemic is very high, some say even certain," as he began a tour of Southeast Asia to co-ordinate plans to combat bird flu on Monday.

"Whether or not H5N1 is the virus that will ultimately trigger such a pandemic is unknown to us," he told a news conference.

The H5N1 strain of bird flu has swept through poultry populations in many parts of Asia since 2003 and was contracted by humans, killing 60 people, mostly through direct contact with sick fowl.

However, the fears then that many more people would get infected did not materialise and the virus was contained, although it caused untold harm to the travel industry.

Now the latest cases found in fowl in Turkey and just recently in Romania have rekindled the fear as the virus has spread to Europe.

But so far most sources say there have been no known cases of person-to-person transmission. Yet, there is one known case of it spreading from one person to another, according to Dr Jeffrey Staples, senior medical adviser at International SOS, who did not give further details in an interview with Channel News Asia.

It is the possibility that H5N1 would mutate into a form that spreads easily among people that would cause the pandemic.

"The probability is uncertain. But the warning signs are troubling. Hence we are responding in a robust way," said Michael Leavitt.

But General Lee Jong-wook, the World Health Organisation director, showed no uncertainty. He warned on Thursday that it is only a matter of time before the bird flu virus mutates to spread human-to-human and causes a pandemic.

Is he exaggerating? Imagine the reaction of the authorities had a media person uncovered such a threat and used those same words.

Apparently, the WHO director thought it was better to exaggerate the threat now than be sorry after the fact, according to reports.

"We can't say exactly when, but that event is clearly on the way. And when that happens, even speaking conservatively, millions will lose their lives. There will be countries that simply will not be able to cope with the situation, as well as leaders who will not be capable of handling the response after the fact.

"Even if we end up being criticised later because causalities did not meet our predictions, the objective of our warning now is to inform the public of the seriousness of the threat posed by the avian flu, and to make sure that people make adequate provisions ahead of time."

Now it is all very well to keep the public informed, and I must say the leaflet published by the local Ministry of Health, based on the UK's NHS advice, is very good in that it deals with the issue within the right perspective.

It presents the facts clearly and attempts to allay unnecessary fears. But the WHO director saying that the event, which would kill millions "is clearly on the way" and that countries and their leaders "will not be able to cope" is alarmist, to say the least.

Besides, what is the point of telling the public that a pandemic is a certainty and that few countries are equipped to cope? Isn't that bound to create panic?

The only reason I can think of, for this unusual reaction from the WHO, is that the organisation thinks the authorities in some countries are not taking the threat seriously enough, and that the media attention, which such announcements are bound to attract, will push complacent authorities into action and issue clear guidelines.

Or maybe it is the pharmaceutical companies the WHO is trying to mobilise. So far only Roche has the patent for the drugs - Tamiflu and the inhaled drug Relenza - that could reduce the severity of a flu if administered within 48 hours of the initial infection.

The two drugs that fight regular flu are thought to be effective in treating flu caused by H5N1 if administered quickly. They also may help prevent infection.

However, this claim is disputed by Michael Osterholm, an infectious disease expert advising the US government, who said that if the H5N1 bird flu virus infects humans, it will move too quickly for drugs and vaccines to be of much use.

And in the wake of a US scientist's warning that a drug-resistant avian flu strain could arise with unrestrained and improper use of available drugs, Justin Teo of Channel News Asia interviewed Dr Staples, who said that Osterholm was absolutely correct in a lot of ways.

"If this virus mutates into a human pandemic form, we'll not have a vaccine for that virus probably for six to nine months because we don't know what the virus looks like yet, and so we can't make a vaccine for it.

"French vaccine maker Sanofi-Pasteur has begun production of a vaccine against H5N1. But researchers have not settled on how large a dose will ensure protection.

"H5N1 is seen as a candidate to cause a global flu pandemic if it mutates into a form capable of spreading easily from person to person. Because people have not developed immunity to H5N1, unlike the usual strains of human flu, it could have more severe effects on a greater number of people," Dr Staples said.

Current thinking by the authorities is that humans primarily get bird flu from contact with excretions from infected birds, not from other people with the illness. Common victims are people who handle poultry on farms or at live markets.

The symptoms of bird flu in humans can include typical flu-like symptoms, like fever, cough, sore throat and muscle aches, as well as eye infections, pneumonia and severe respiratory illness. It can be detected through a blood test of a person suspected of having it.

"I think the world in general is looking for a sure thing, quick-easy fix, in terms of vaccine and medication. Where there certainly is a reasonable component of a preparedness pandemic plan, this in itself would not be able to stop the pandemic should one occur.

"So alternatives are really good, comprehensive planning for infrastructure, communications, transportation, logistics and supplies, and planning alternative sources and alternative means of getting critical operations done. We basically have to figure out how we can operate our society should a pandemic occur and we shouldn't just rely on vaccines and drugs", he said.

The WHO, the Food and Agriculture Organisation, the World Organisation for Animal Health and the World Bank will co-sponsor a partners meeting on avian influenza and human pandemic influenza on November 7-9 at WHO headquarters in Geneva.

The agenda behind the WHO director's frightening message is not clear to me at all, because a drug to combat the virus, if indeed it does mutate to become transferable from human to human, cannot be made until the virus mutates and is identified.

So the public can't do much except keep away from birds. The people most at risk, if the current bird flu reaches Malta, are those dealing with poultry.

It is necessary to ensure that farmers get enough compensation when they slaughter and dispose of chickens and ducks that show signs of infection, if not they might be reluctant to admit that their birds are infected.

Resources should be focused on the reduction of close contacts between humans, domestic poultry and wildlife through better management practices and improved bio-security practices in poultry production enterprises, especially those that are small and 'open-air' - where domestic poultry and waterfowl are allowed to mingle with wild birds.

Limiting contact with wild birds should therefore be part of any avian influenza control strategy.

But if the virus does mutate to what the Cassandras are predicting, God help us.

phansen@timesofmalta.com