Patent Baristas

Well, technically, that’s true but the real issue is: Are we obsessed with cataclysmic threats? Flu experts, including the World Health Organization, are warning that avian flu could be the Big One, an apocalyptic nightmare from a Hollywood script with each report giving more dire predictions. On Thursday, Dr. David Nabarro — the new U.N. coordinator for avian and human influenza — had warned that the “range of deaths could be anything between 5 and 150 million” from a new pandemic. Dr. Michael Osterholm, director for the Center of Infectious Disease Research and Policy at the University of Minnesota, who prophesies a death toll upwards of 360 million(!) Whoa, this wild-guessing fear-mongering arms race has really gotten out of hand.

The WHO has now backed away from these “flu tsunami” death toll estimates saying pandemic toll predictions are “guesswork” and that Nabarro was just suggesting the range of expert opinion on the subject. The WHO believes the estimate of 2 million to 7.4 million deaths, based on a study by the US Centers for Disease Control and Prevention, “is the most reasoned position,” according to a Reuters report. Some reports estimate less than 50,000 deaths – a few orders of magnitude different from 360 million.

It seems like we’re always bracing for the next imminent disaster-of-the-month — fueled by the news organizations that tend to play off each other hyping the latest doomsday scenario: tsunamis, hurricanes, apocalyptic plagues, terrorism, earthquakes, killer bees, the Macarena, etc.

Not that there isn’t a threat, mind you. H5N1, the deadly strain of avian influenza that has been spreading fear throughout Southeast Asia since late 2003, and may be heading west. The virus has already infected 115 humans, killing 59 — with 16 more people under observation in a Jakarta hospital — and commercial poultry flocks in China, Vietnam, Cambodia, Indonesia, Laos, Thailand, Hong Kong and Russia. Most human cases have been linked to contact with sick birds. The WHO has warned that the virus could mutate into a form that spreads easily among humans — possibly triggering a global pandemic that could kill millions.

There have been three flu pandemics in the last century: the Spanish flu of 1918-19, the Asian flu of 1957-58 and the Hong-Kong flu of 1968-69 which resulted in tens of millions of deaths worldwide. Experts have identified specific criteria that preclude and predict the outbreak of a pandemic and all but one have been met in regard to the H5N1 strain of bird flu – an efficient human-to-human transmission mechanism.

“Spanish flu,” involving influenza A (H1N1), was the largest rapidly fatal pandemic in human history. The virus traversed the world in less than 1 year, causing at least 40 million deaths. Many people died within a few days of the onset of symptoms. Autopsies often showed a characteristic hemorrhagic, necrotizing viral pneumonia—not a bacterial superinfection that might now respond to antibacterial agents. The average time to death in 1918 was about 7 to 9 days after the onset of illness, an interval that might allow for intervention with specific antiviral therapy, if available. Subsequent studies of the 1918 strain showed that it had a constellation of genes that account for this unique virulence, although recent studies have pointed to a unique virulence related to the hemagglutinin of the 1918 strain.

But not everything is a disaster in the making. Generally, people don’t tend to look at the probabilities – like when the Alar scare made people stop eating apples. How concerned should we be? The fact of the matter is, we’ve been awaiting an imminent H5N1 outbreak for several years, and even in China, a country of 1.3 billion people, an epidemic has not materialized. We have no way of knowing whether the virus will mutate into a form that will spread easily among humans. And even if it does — unlike the 1918 situation when Spanish flu spread quickly and quietly in the disease-infested trenches of the First World War — today we have means to anticipate, plan for and contain viruses.

Worried that avian flu could spur an influenza pandemic in the United States, the U.S. Department of Health and Human Services has awarded $100 million to France’s Sanofi Pasteur of Sanofi-Aventis to manufacture a vaccine and another $2.8 million to the United Kingdom’s GlaxoSmithKline for its antiviral drug Relenza. Now, the US Senate voted yesterday to provide $4 billion for antiviral drugs and other measures to prepare for a feared influenza pandemic. Almost $3.1 billion of the money would be used to stockpile the antiviral drug oseltamivir (Tamiflu), and the rest would go for global flu surveillance, development of vaccines, and state and local preparedness, according to a Reuters report. The government currently has enough oseltamivir to treat a few million people, with a goal of acquiring enough to treat 20 million.

Tamiflu is produced by the Swiss pharmaceutical firm Hoffmann-La Roche Ltd. and belongs to a group of medicines called neuraminidase inhibitors, which attack the flu virus and prevent it from spreading inside the body. The problem is, it’s a complex drug and a single dose takes 12 months to produce. Currently, it’s only manufactured in a single plant in Switzerland, but the company has plans to expand its facilities.

Relax, try to get outside and get some fresh air today. You’ll be OK – as long as you don’t drive on the highway while all the road rage maniacs are out there…