Families and communities need to prepare plans
Flu pandemic - it's mainly a matter of when

Most experts agree a worldwide flu epidemic is going to occur. It's just a matter of when and how severe, according to a doctor here who is consulting on preparedness plans for Big Canoe and several companies.
The question seems to be whether the potential flu pandemic will be similar to the previous ones of 1958 and 1968 or on the magnitude of the 1918 epidemic which killed 50 million to 100 million people worldwide.
Pandemics (worldwide epidemics) have historically occurred three times in a century. In the past century, the flu pandemics of 1958 and 1968 have been largely forgotten, but the prospect of seeing a deadly flu strain quickly spread around the globe as it did in 1918 has experts worried.
Dr. R. Burt Prater of Big Canoe said families and communities need to prepare flu pandemic plans now for coping with the problems of caring for the sick and maintaining civil services and infrastructure should a worse case scenario occur.
Dr. Prater is part of a committee preparing a plan for Big Canoe. He also consults for several companies preparing avian flu response plans. In the course of his work, Dr. Prater distributes an e-mail newsletter on avian flu.
In his last newsletter, he noted, "The 20 most qualified international experts in this field agree that a pandemic of some proportion is inevitable, and that, considering the current events, is likely in the next year or two."
Events the newsletter references can be read almost daily in newspapers and magazines, concerning the further spread of the flu virus, known to researchers as H5N1. Among headlines this March were fatalities among people in Iraq and the spread of the virus among animals in Europe.
In an interview in early March, Dr. Prater said there is close to a 100 percent chance of a pandemic in the next three to five years, according to almost all experts.
But there is a lot left unknown, such as how deadly the pandemic would be.
"There are far more questions than answers," he said. "No one knows when or how severe, but the general agreement is we will have a pandemic."
The doctor provided general information on influenza and a history of the virus.
Among the key differences between avian flu and the seasonal flu, which we are familiar with every year, is that the yearly strain is a very low pathogenic virus. It kills a number of people every year but not a widespread number, and fatalities are mainly among the old and young.
On the other hand, the Avian flu is a highly pathogenic virus. That means it has a high death rate or case fatality rate.
The case fatality rate for avian flu is around 50 percent. Recent reports show at least 175 people have been affected and more than 95 of these have died. To put this in perspective, the case fatality rate for the seasonal flu is 0.1 percent.
The virus has been found in at least 35 different countries; the bulk of these in Asia and the Far East.
China, Malaysia, Vietnam and Indonesia have been among countries where the virus is most prevalent.
"We have had a number of cases in Turkey with three fatalities among ten people infected. It has also been confirmed in Iraq with three human fatalities," Dr. Prater said.
According to the latest newsletter, the first 21st century human case of the H5N1 strain of influenza virus occurred in Vietnam in 2003. However the first recorded case of humans being infected with an Avian virus like H5N1 since 1918 occurred in Hong Kong in 1977.
One theory cited in the newsletter says this is the same virus which caused the 1918 pandemic. The virus had been dormant in wild water fowl populations for many years, but for some unknown reason became active again, killing wild bird hosts and infecting domestic fowl, particularly chickens.
In countries where the virus has been most common, people live in close proximity to domestic fowl as food resources or as pets. In Nigeria, for example, almost everyone has a flock of chickens in their backyard.
For the first time in recent history, there are widespread incidents of highly pathogenic (deadly) flu in fowl population, primarily waterfowl and chickens. The concern is that this virus in birds will develop the ability for effective human to human transmission, and that is troublesome, said Dr. Prater.
"Thus far, there has been minimal documentation of human to human transmission," he said. "There has been some with very close contact. For the most part, human cases were passed by direct contact with fowl. "
There are three conditions necessary for a pandemic (worldwide epidemic) and two have already been met, according to the doctor.
First, the rise of highly pathogenic avian virus in fowl population.
Second, a virus to which the human population has no residual immunity. "We do not have any immunity to this virus. Everybody who developed immunity in the 1918 worldwide flu epidemic is, of course, now dead," according to Dr. Prater.
Third is the ability of the bug to be transmitted effectively from human to human. Apparently it hasn't done this so far.
By nature, influenza is a virus capable of quickly mutating or recombining. "It is an opportunistic virus - it can mutate frequently to replicate itself to further spread," said Dr. Prater.
His newsletter stated, "If the virus is capable of continued change and becomes efficient in human to human transmission, it could well set off a world pandemic that could travel across the globe within weeks to several months."
In 1918, the virus took the world by surprise, said Dr. Prater. "It circled the globe in less than one year during a time with no significant air travel, only boats."
There were only a few small islands in the South Pacific where the virus didn't show up.
The flu pandemic of 1918 killed between 50 million and 100 million people worldwide, with deaths in the United States ranging between 500,000 and 700,000. In October of 1918, in the city of Philadelphia, 12,000 people died of the virus.
The case fatality rate worldwide for the 1918 pandemic was less than 3 percent. The rate of this current bug is better than 50 percent among the much smaller sampling where it has been detected.
If you were to project a pandemic with the previous case fatality rate of 3 percent occurring today with the larger world population, it would mean the death of several billion people.
What concerns experts is all conditions have been met for another pandemic except effective human to human transmission. But the longer the avian flu remains active and spreads, the more opportunity it has to re-combine into a form that can be spread easily among people.
Going back to 1918, there is some disagreement about whether the flu started in Boston or Kansas. From Boston it took four weeks to reach nine states on the eastern seaboard at a time when we had no superhighways. In another four weeks it was on the west coast.
Unfortunately, there is no vaccine. You can't make vaccine for a virus until you know what it will be, and the avian flu will almost certainly mutate before it develops an ability to be highly transmittable.
"Trying to make vaccine now would be wasted time, energy and money," Dr. Prater said.
Once we can determine the form of the virus, it will take eight to twelve months to develop a vaccine, even knowing what we know today, he said.
Another remedy is to treat with Tamiflu (an anti-viral medication). But the supply of Tamiflu is very restricted, even among more wealthy nations. And it has proven somewhat ineffective in treating cases of avian flu where it has been tried, Prater said.
To make matters worse, influenza viruses mutate quickly to develop resistance. "There is a great fear this would happen very fast. It would develop a resistance," Dr. Prater said. "There is no effective means to treat the virus if it happens, which is very bothersome."
Dr. Prater believes the best thing everyone can do is prepare both family plans and plans for a community response. The Georgia Department of Human Resources Division of Public Health made the same recommendation on March 16.
Dr. Prater said he is bothered by the way many people are either ill-informed or lackadaisical concerning avian flu.
Many people say when it gets to the United States, they'll concern themselves, but, unfortunately, that will be too late.
He said many communities are in the early phases of working on preparedness plans. Dr. Prater is working on one for Big Canoe.
He is also consulting with companies on plans for continuing production with an ill workforce.
He said most larger companies are developing plans to remain profitable or at least in operation should a large number of workers either become ill or not report for work over fear of catching the disease.
He said every community should already be considering where they might house the ill and who would care for them. There are nowhere near enough hospital beds to handle a major pandemic. In America, there are only one million staffed hospital beds and the majority are already filled with heart attacks, people having babies and other regular medical issues.
"If we have 4 million to 5 million very sick people, there would be no place for them to go," Prater said.
There should also be plans for redundancy to assist civil servants. He said firemen, police ,and people operating infrastructure will not be spared from the disease, and plans for keeping these necessary agencies operational should be made well in advance.
As to what you can do on a family level:
First is to be informed, according to the doctor.
His recent newsletter cited several references of the internet including www.fluwickie.com, www.pandemicflu.gov and the World Health Organization www.who.int/en/. He did warn to watch out for internet sites which are filled with misinformation. In this, like most subjects, there are websites which are both naysayers and those too alarmist. He referred to these as "ostriches," ignoring the problem and "chicken littles" believing the sky is falling.
Social distancing is the key in epidemics. Staying away from other humans as much as possible increases your chance of not catching the virus, Prater said. School closings along with avoiding social gatherings and places like movies would be among important measures to take.
It's not enough just to stay away from the sick. You can be infected and have no symptoms for two or three days and spread the disease during that time, he said.
Prater's newsletter recommends the same personal habitats encouraged to avoid regular flu strains - such as frequent handwashing, and being conscious of not rubbing your eyes, putting fingers in your mouth or nose.
Many of the recommendations made by the Big Canoe doctor were publicly announced by the the Georgia Department of Human Resources Division of Public Health on March 16.
The Georgia health agency said they have held pandemic summits to prepare and have also encouraged businesses to begin planning.
"A pandemic will affect every aspect of our society - businesses, community organizations, schools, individuals and families. We want to send a message that there are actions you can take that will minimize the risk to your health and safety, your business, and your community. Now is the time to start thinking about that," said Dr. Stuart Brown, director of the Georgia Department of Human Resources Division of Public Health.