PureInsight | July 4, 2005
An influenza pandemic is coming, public health experts worldwide agree. The main questions remaining are: when it will happen, and how effectively will our health care systems respond to it?
"There's no way to nip this thing in the bud; it will happen. It's just a question of when," said Dr. Trevor Corneil, Clinical Associate Professor at the University of British Columbia and part of the province's avian flu pandemic planning team.
Known as the "bird flu," the avian influenza H5N1 strain first raised eyebrows about its potential to develop into a pandemic in January 2004. At that time, a deadly bird epidemic was sweeping across Asia and appearing in pockets of Europe and North America. It devastated poultry farmers with the loss of over 100 million birds, either from the disease itself or preventative culling. The alarm bells really started ringing about 18 months ago when the flu "jumped the species barrier," and for the first time began appearing in humans in Thailand and Vietnam.
Now, there is mounting evidence of human-to-human transmission, an essential condition for a pandemic to emerge. According to a recent World Health Organization (WHO) report, although no human-to-human infection has been confirmed, in Vietnam "the pattern of disease appear[s] to have changed in a manner consistent with this possibility."
There are many reasons why experts are bracing for the worst. One is that "major outbreaks happen every 15-25 years," according to Corneil. "It's now been over 30 years…we're due." The worst outbreak of the 20th century was the 1918-19 Spanish Flu, which killed over 50 million worldwide; it also began as an avian virus.
Another cause for concern is the high fatality rate of those already infected. Of the 100 H5N1 human cases recorded by the WHO in Vietnam, Thailand and Cambodia, 55 have died. "An H5N1 virus with this ability could lead to a global pandemic and many millions of deaths worldwide," warns the WHO report.
In Canada, Corneil anticipates that "20 percent of all Canadians will be infected, including one-third of health care providers." This, he concludes, will have a massive effect on health services delivery, as well as the economy, with that many people sick.
Australian Health Minister, Tony Abbott, estimates his country could see "2.6 million Australians seeking medical attention, 58,000 needing hospitalization and 13,000 deaths."
The Center for Disease Control and Prevention predicts that even a "medium-level pandemic" would affect "between 15 percent and 35 percent of the US population." Worldwide, the death rate could be up to 7.4 million.
The potential good news is that with global disease surveillance and strategic planning, the worst might be avoided. The crucial piece of the containment puzzle, however, will be the effectiveness of communication among global health authorities.
Therein lies the rub. The system breaks down if information isn't shared quickly and completely. Many people are questioning the reliability of the reporting from within China's borders, largely due to the Chinese government's initial cover-up of the SARS epidemic and a history of denial when problems do arise.
"There is a question about China," says Corneil, describing the situation there as "a big mystery." Until recently, during the extensive bird flu outbreaks in eight Asian countries, China admitted to only 50 cases which it "successfully…brought under control," according to China's state-controlled media.
"There's an ongoing struggle around what actually has happened [in China]…between the WHO and China. Scientists and doctors [are] saying one thing, and the government [is] saying another. You just don't have the political interference [with respect to] information that is released…in most other countries," says Corneil.
