Commentary: Fears are not justified

[Guest guest]

Commentary: Remote threat

Fears are not justified for Washington's preparations against the

spread of `killer' influenza to humans

By Al Zelicoff, Tribune Columnist

November 15, 2005

The sky is falling and millions of us are going to die.

That's the message one takes from the headlines, including in

generally staid journals, like Nature, Science and Foreign Affairs -

where entire issues have been devoted to fears of a coming pandemic

due to a new subtype of bird flu called H5N1.

It was first identified in 1996 in Southeast Asia and is now

circulating widely among birds - both migratory and agricultural - in

China, Russia and most countries of east Asia. So, are the fears

justified for Washington's preparations against the spread of this

new " killer " influenza to humans? The short answer is no. The threat

is extremely remote.

Which is why the $7 billion plan proposed by President Bush is vastly

overpriced. It ignores the one relatively inexpensive thing that

might truly make a difference if this or similar threats were every

realized.

That is establishing a real-time national health monitoring system,

which I will address in a second article to be published here

Wednesday. But, first, a review of basic biology is in order.

The influenza virus is primarily a bird disease; humans appear to be

an unnecessary host. The virus types circulating at any given moment

are characterized by two chemicals on their surface: hemagglutinin

(H) and neuraminidase (N). Both are necessary for the virus to invade

cells in birds or other species and multiply. So the annual vaccine

contains the H and N proteins of the currently circulating strains

which induce antibodies in the recipient that then block the ability

of the proteins to allow viral spread among host cells. At least 16 H

types have been identified in birds and 9 distinct N types, but only

about half a dozen combinations of various H and N proteins result in

viruses that are known to cause disease in humans.

The flu fear-mongers advance the following rationale for worry:

The " pandemic " flu (that is influenza that is truly global in spread

and high in incidence) comes in more or less regular cycles.

We are overdue for a new subtype of flu because it has been nearly 40

years since the last flu pandemic.

Because some humans (about 100 to date) have clearly acquired H5N1

influenza, most probably from birds, it appears that this new subtype

does not seem to require an intermediate species (typically pigs) on

its way to human adaptation.

Half of the 120 people known to have become infected with H5N1 have

died.

And lastly, they say since H5N1 is carried by migratory birds, it is

only a matter of time that highly lethal influenza (for humans) is

spread around the globe.

Each of these arguments is scientifically specious. Take the belief

in periodicity of influenza. There is no evidence that pandemic

influenza comes at regular intervals. There have been three only in

the 20th century (1918, 1957, 1968) and any high school math student

will tell you that 3 points in time don't define a periodic cycle.

Rather, pandemics occur from random mutations in influenza genes

(most of which result in viruses that infect no species, so they die

out). Just like flipping a coin, pandemics are thus random. We are

not overdue, just simply no more due this year than we have been in

any year.

Second, of the hundreds of billions of interactions between humans

and infected birds in Asia, there have resulted but 120 cases of H5N1

disease. Nature magazine reports that tens of millions of rural

Chinese already carry antibodies to some varieties of H5N1,

indicating they have become infected in the past seven years and

their immune systems eliminated the virus without resulting illness.

Third, staff at a hospital in Thailand treating all H5N1 patients

were tested to see if they developed antibodies to the virus. Not a

single health care worker did, indicating no spread from patients.

Fourth, since dead birds don't fly, it is impossible for migratory

fowl to spread a lethal virus (lethal to them, at least) over large

distances. Just two months ago, geese and ducks were dying by the

thousands in Asia. They no longer are, as other less lethal strains

developed.

Fifth, just about everyone in the United States is already carrying

antibodies to the N1 component of the virus and studies with

immunized mice later exposed showed full protection against death.

Finally, the conditions of crowding in 1918 that spread the flu -

troops in trenches and massive hospital wards, people living in

tenements - simply aren't prevalent today.

All of which is why the president's current scheme spends far too

much to get too little of what we really need - preparation for

pandemics in general, with the priority on much improved routine

disease surveillance, which I address in Wednesday's article.

http://www.abqtrib.com/albq/op_commentaries/article/0,2565,ALBQ_19866_

4240334,00.html

TODAY'S BYLINE

Zelicoff, president of Scientific Medical and Legal Review, is an

Albuquerque physician, physicist and consultant. He is a former

distinguished scientist at Sandia National Laboratories in

Albuquerque.

This is the first of two articles he has written on the threat of

bird flu. The second will appear Wednesday on the SYRIS disease

reporting system, which he helped create and develop.