copyright,2006,http://birdflubook.com/index.php ----------------------------------------------- Bird Flu - BirdFluBook.com [1] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2] (c) BirdFluBook.com | Home [3] | Website by Lantern Media [4] Bird Flu - R20;Humanity has but three great enemies: fever, famine and war; of these by far the greatest, by far the most terrible, is fever.R21; BirdFluBook.com [5] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [6] R20;Humanity has but three great enemies: fever, famine and war; of these by far the greatest, by far the most terrible, is fever.R21; R12;Sir William Osler3 [7] Emergency hospital during 1918 pandemic, Kansas It started, harmlessly enough, with a cough drowned out by the raging world war. It was known as Spanish influenza only because censorship by the warring governments wouldnR17;t allow reports of the spreading illness for fear it would damage morale.4 [8] However, Spain, being neutral, allowed its press to publicize what was happening. The first cable read, R20;A STRANGE FORM OF DISEASE OF EPIDEMIC CHARACTER HAS APPEARED IN MADRID.R21; Because of the censors, even as millions were dying around the globe, the world press was apt to report little about the pandemic beyond what the Spanish King AlfonzoR17;s temperature was that morning.5 [9] In Spain they called it the French flu.6 [10] R20;The year 1918 has gone,R21; the editors of the Journal of the American Medical Association wrote in the Christmas issue, R20;a year momentous as the termination of the most cruel war in the annals of the human race; a year which marked the end, at least for a time, of manR17;s destruction of man; unfortunately a year in which developed a most fatal infectious diseaseR30;.R21;7 [11] That most fatal disease killed about 10 times more Americans than did the war.8 [12] In fact, according to the World Health Organization (WHO), R20;The 1918 influenza pandemic killed more people in less time than any other disease before or since,R21;9 [13] the R20;most deadly disease event in the history of humanityR30;.R21;10 [14] The word R20;epidemicR21; comes from the Greek epi, meaning R20;upon,R21; and demos, meaning R20;people.R21; The word R20;pandemicR21; comes from the Greek word pandemos, meaning R20;upon all the people.R21;11 [15] Most outbreaks of disease are geographically confined, just like most disasters in general. Wars, famines, earthquakes, and acts of terror, for example, tend to be localized both in time and space. We look on in horror, but may not be affected ourselves. Pandemics are different. Pandemics are worldwide epidemics. They happen everywhere at once, coast to coast, and can drag on for more than a year.12 [16] R20;With Hurricane Katrina, people opened their homes, sent checks and people found safe havens,R21; writes a global economic strategist at a leading investment firm, but with a pandemic, R20;there is nowhere to turn, no safe place to evacuate.R21;13 [17] The word R20;influenzaR21; derives from the Italian influentia, meaning R20;influence,R21; reflecting a medieval belief that astrological forces were behind the annual flu season.14 [18] In 1918, though, the Germans called it Blitzkatarrh.15 [19] To the Siamese, it was Kai Wat Yai, The Great Cold Fever.16 [20] In Hungary, it was The Black Whip. In Cuba and the Philippines, it was Trancazo, meaning R20;a blow from a heavy stick.R21; In the United States, it was the Spanish Lady, or, because of the way many died, the Purple Death. (c) BirdFluBook.com | Home [21] | Website by Lantern Media [22] Bird Flu - Purple Death BirdFluBook.com [23] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [24] Purple Death Influenza ward in army general hospital, Fort Porter, New York (National Archives, 165-WW-269-B-4) What started for millions around the globe as muscle aches and a fever ended days later with many victims bleeding from their nostrils, ears, and eye sockets.17 [25] Some bled inside their eyes;18 [26] some bled around them.19 [27] They vomited blood and coughed it up.20 [28] Purple blood blisters appeared on their skin.21 [29] The Chief of the Medical Services, Major Walter V. Brem, described the horror at the time in the Journal of the American Medical Association. He wrote that R20;often blood was seen to gush from a patientR17;s nose and mouth.R21;22 [30] In some cases, blood reportedly spurted with such force as to squirt several feet.23 [31] R20;When pneumonia appeared,R21; Major Brem recounted, R20;the patients often spat quantities of almost pure blood.R21;24 [32] They were bleeding into their lungs. As victims struggled to clear their airways of the bloody froth that poured from their lungs, their bodies started to turn blue from the lack of oxygen, a condition known as violaceous heliotrope cyanosis.25 [33] R20;TheyR17;re as blue as huckleberries and spitting blood,R21; one New York City physician told a colleague.26 [34] U.S. Army medics noted that this was R20;not the dusky pallid blueness that one is accustomed to in failing pneumonia, but rather [a] deep blueness…an indigo blue color.R21;27 [35] The hue was so dark that one physician confessed that R20;it is hard to distinguish the colored men from the white.R21;28 [36] R20;It is only a matter of a few hours then until death comes,R21; recalled another physician, R20;and it is simply a struggle for air until they suffocate.R21;29 [37] They drowned in their own bloody secretions.30 [38] R20;It wasnR17;t always that quick, either,R21; one historian adds. R20;And along the way, you had symptoms like fingers and genitals turning black, and people reporting being able to literally smell the body decaying before the patient died.R21;31 [39] R20;When youR17;re ill like that you donR17;t care,R21; recalls one flu survivor, now 100 years old. R20;You donR17;t care if you live or die.R21;32 [40] Major Brem described an autopsy: R20;Frothy, bloody serum poured from the nose and mouth when the body was moved, or the head lowered…. Pus streamed from the trachea when the lungs were removed.R21;33 [41] Fellow autopsy surgeons discussed what they called a R20;pathological nightmare,R21; with lungs up to six times their normal weight, looking R20;like melted red currant jelly.R21;34 [42] An account published by the National Academies of Science describes the lungs taken from victims as R20;hideously transformedR21; from light, buoyant, air-filled structures to dense sacks of bloody fluid.35 [43] There was one autopsy finding physicians reported having never seen before. As people choked to death, violently coughing up as much as two pints of yellow-green pus per day,36 [44] their lungs would sometimes burst internally, forcing air under pressure up underneath their skin. In the Proceedings of the Royal Society of Medicine, a British physician noted R20;one thing that I have never seen beforeR12;namely the occurrence of subcutaneous emphysemaR21;R12;pockets of air accumulating just beneath the skinR12;R20;beginning in the neck and spreading sometimes over the whole body.R21;37 [45] These pockets of air leaking from ruptured lungs made patients crackle when they rolled onto their sides. In an unaired interview filmed for a PBS American Experience documentary on the 1918 pandemic, one Navy nurse compared the sound to a bowl of Rice Krispies. The memory of that soundR12;the sound of air bubbles moving under peopleR17;s skinR12;remained so vivid that for the rest of her life, she couldnR17;t be in a room with anyone eating that popping cereal.38 [46] (c) BirdFluBook.com | Home [47] | Website by Lantern Media [48] Bird Flu - R20;[A] dead man has no substance unless one has actually seen him dead; a hundred million corpses broadcast through history are no more than a puff of smoke in the imagination.R21; BirdFluBook.com [49] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [50] R20;[A] dead man has no substance unless one has actually seen him dead; a hundred million corpses broadcast through history are no more than a puff of smoke in the imagination.R21; R12;Albert Camus, The Plague39 [51] Percent of population dying in U.S. cities In 1918, half the world became infected and 25% of all Americans fell ill.40 [52] Unlike the regular seasonal flu, which tends to kill only the elderly and infirm, the flu virus of 1918 killed those in the prime of life Public health specialists at the time noted that most influenza victims were those who R20;had been in the best of physical condition and freest from previous disease.R21;41 [53] Ninety-nine percent of excess deaths were among people under 65 years old.42 [54] Mortality peaked in the 20- to 34-year-old age group.43 [55] Women under 35 accounted for 70% of all female influenza deaths. In 1918, the average life expectancy in the United States dropped precipitously to only 37 years.44 [56] Calculations made in the 1920s estimated the global death toll in the vicinity of 20 million, a figure medical historians now consider R20;almost ludicrously low.R21;45 [57] The number has been revised upwards ever since, as more and more records are unearthed. The best estimate currently stands at 50 to 100 million people dead.46 [58] In some communities, like in Alaska, 50% of the population perished.47 [59] The 1918 influenza pandemic killed more people in a single year than the bubonic plague (R20;black deathR21;) in the Middle Ages killed in a century.48 [60] The 1918 virus killed more people in 25 weeks than AIDS has killed in 25 years.49 [61] According to one academic reviewer, this R20;single, brief epidemic generated more fatalities, more suffering, and more demographic change in the United States than all the wars of the Twentieth Century.R21;50 [62] In September 1918, according to the official published American Medican Association (AMA) account, the deadliest wave of the pandemic spread over the world R20;like a tidal wave.R21;51 [63] On the 11th, Washington officials disclosed that it had reached U.S. shores.52 [64] September 11, 1918R12;the day Babe Ruth led the Boston Red Sox to victory in the World SeriesR12;three civilians dropped dead on the sidewalks of neighboring Quincy, Massachusetts.53 [65] It had begun. When a R20;typical outbreakR21; struck Camp Funston in Kansas, the commander, a physician and former Army Chief of Staff, wrote the governor, R20;There are 1440 minutes in a day. When I tell you there were 1440 admissions in a day, you realize the strain put on our Nursing and Medical forcesR30;.R21;54 [66] R20;Stated briefly,R21; summarized an Army report, R20;the influenzaR30;occurred as an explosion.R21;55 [67] October 1918 became the deadliest month in U.S. history56 [68] and the last week of October was the deadliest week from any cause, at any time. More than 20,000 Americans died in that week alone.57 [69] Numbers, though, cannot reflect the true horror of the time. (c) BirdFluBook.com | Home [70] | Website by Lantern Media [71] Bird Flu - R20;They died in heaps and were buried in heaps.R21; BirdFluBook.com [72] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [73] R20;They died in heaps and were buried in heaps.R21; R12;Daniel Defoe, 1665 Mass graves being dug in 1918 One survivor remembers the children. R20;We had little caskets for the little babies that stretched for four and five blocks, eight high, ten high.R21;58 [74] Soon, though, city after city ran out of caskets.59 [75] People were dying faster than carpenters could make them.60 [76] The dead lay in gutters.61 [77] One agonized official in the stricken East sent an urgent warning West: R20;Hunt up your wood-workers and set them to making coffins. Then take your street laborers and set them to digging graves.R21;62 [78] When New York City ran out of gravediggers, they had to follow PhiladelphiaR17;s example and use steam shovels to dig trenches for mass graves.63 [79] Even in timber-rich Sweden, the dead were interred in cardboard boxes or piled in mass graves because they simply ran out of nails.64 [80] Another survivor recalls: A neighbor boy about seven or eight died and they used to just pick you up and wrap you up in a sheet and put you in a patrol wagon. So the mother and father are screaming, R20;Let me get a macaroni boxR21;R12;macaroni, any kind of pasta, used to come in this box, about 20 pounds of macaroni fit in itR12; R20;please, please let me put him in a macaroni box, donR17;t take him away like thatR30;.R21;65 [81] One nurse describes bodies R20;stacked in the morgue from floor to ceiling like cordwood.R21; At the peak of the epidemic, she remembers toe-tagging and wrapping more than one still-living patient in winding sheets. In her nightmares, she wondered R20;what it would feel like to be that boy who was at the bottom of the cordwood in the morgue.R21;66 [82] They brought out their dead. Corpses were carted away in anything, wheelbarrowsR12;even garbage trucks.67 [83] Often, though, the bodies were just pushed into corners and left to rot for days. People too sick to move were discovered lying next to corpses.68 [84] All over the country, farms and factories shut down and schools and churches closed. Homeless children wandered the streets, their parents vanished.69 [85] The New York Health Commissioner estimated that in New York City alone, 21,000 children lost both parents to the pandemic.70 [86] Around the world, millions were left widowed and orphaned.71 [87] The New York Times described Christmas in Tahiti.72 [88] R20;It was impossible to bury the dead,R21; a Tahitian government official noted. R20;Day and night trucks rumbled throughout the streets filled with bodies for the constantly burning pyres.R21;73 [89] When firewood to burn the bodies ran out in India, the rivers became clogged with corpses.74 [90] In the remote community of Okak, in northern Labrador, an eight-year-old girl reportedly survived for five weeks at 20 below zeroR12;among the corpses of her family. She kept herself alive by melting snow for water with the last of her Christmas candles while she lay listening to the sound of dogs outside feasting off the dead.75 [91] Colonel Victor Vaughan, acting Surgeon General of the Army and former head of the AMA, lived through the pandemic. R20;If the epidemic continues its mathematical rate of acceleration,R21; Vaughan wrote in 1918, R20;civilization could easily disappear from the face of the earth.R21;76 [92] But the virus did stop. It ran out of human fuel; it ran out of accessible people to infect. Those who lived through it were immune to reinfection, so many populations were, in many respects, either immune or dead. R20;[I]tR17;s like a firestorm,R21; one expert explained. R20;[I]t sweeps through and it has so many victims and the survivors developed immunity.R21;77 [93] Influenza is R20;transmitted so effectively,R21; reads one virology textbook, R20;that it exhausts the supply of susceptible hosts.R21;78 [94] As soon as the dying stopped, the forgetting began. As Arno Karlen wrote in Man and Microbes, R20;Many Americans know more about mediaeval plague than about the greatest mass death in their grandparentsR17; lives.R21;79 [95] Commentators view the pandemic as so traumatic that it had to be forced out of our collective memory and history. R20;I think itR17;s probably because it was so awful while it was happening, so frightening,R21; one epidemiologist speculates, R20;that people just got rid of the memory.R21;80 [96] For many, however, the virus lived on. As if the pandemic werenR17;t tragic enough, in the decade that followed, a million people came down with a serious ParkinsonR17;s-like disease termed R20;encephalitis lethargica,R21; the subject of the book and movie Awakenings.81 [97] Some researchers now consider this epidemic of neurological disease to be R20;almost certainlyR21; a direct consequence of viral damage to the brains of survivors.82 [98] The latest research goes a step further to suggest the pandemic had ripples throughout the century, showing that those in utero at the height of the pandemic in the most affected areas seemed to have stunted lifespans and lifelong physical disability.83 [99] (c) BirdFluBook.com | Home [100] | Website by Lantern Media [101] Bird Flu - R20;This is a detective story. Here was a mass murderer that was around 80 years ago and whoR17;s never been brought to justice. And what weR17;re trying to do is find the murderer.R21; BirdFluBook.com [102] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [103] R20;This is a detective story. Here was a mass murderer that was around 80 years ago and whoR17;s never been brought to justice. And what weR17;re trying to do is find the murderer.R21; R12;Jeffery Taubenberger, molecular pathologist and arche-virologist84 [104] Johan Hultin and Mary Where did this disease come from? Popular explanations at the time included a covert German biological weapon, the foul atmosphere conjured by the warR17;s rotting corpses and mustard gas, or R20;spiritual malaise due to the sins of war and materialism.R21;85 [105] This was before the influenza virus was discovered, we must remember, and is consistent with other familiar etymological examplesR12;malaria was contracted from mal and aria (R20;bad airR21;) or such quaintly preserved terms as catching R20;a coldR21; and being R20;under the weather.R21;86 [106] The committee set up by the American Public Health Association to investigate the 1918 outbreak could only speak of a R20;disease of extreme communicability.R21;87 [107] Though the R20;prevailing disease is generally known as influenza,R21; they couldnR17;t even be certain that this was the same disease that had been previously thought of as such.88 [108] As the Journal of the American Medical Association observed in October 1918, R20;The R16;influenceR17; in influenza is still veiled in mystery.R21;89 [109] In the decade following 1918, thousands of books and papers were written on influenza in a frenzied attempt to characterize the pathogen. One of the most famous medical papers of all time, Alexander FlemingR17;s R20;On the Antibacterial Actions of Cultures of Penicillium,R21; reported an attempt to isolate the bug that caused influenza. The full title was R20;On the Antibacterial Actions of Cultures of Penicillium, with Special Reference to Their Use in the Isolation of B. Influenzae.R21; Fleming was hoping he could use penicillin to kill off all the contaminant bystander bacteria on the culture plate so he could isolate the bug that caused influenza. The possibility of treating humans with penicillin was mentioned only in passing at the end of the paper.90 [110] The cause of human influenza was not found until 1933, when a British research team finally isolated and identified the viral culprit.91 [111] What they discovered, though, was a virus that caused the typical seasonal flu. Scientists still didnR17;t understand where the flu virus of 1918 came from or why it was so deadly. It would be more than a half-century before molecular biological techniques would be developed and refined enough to begin to answer these questions; but by then where would researchers find 1918 tissue samples to study the virus? The U.S. Armed Forces Institute of Pathology originated almost 150 years ago. It came into being during the Civil War, created by an executive order from Abraham Lincoln to the Army Surgeon General to study diseases in the battlefield.92 [112] It houses literally tens of millions of pieces of preserved human tissue, the largest collection of its kind in the world.93 [113] This is where civilian pathologist Jeffery Taubenberger first went to look for tissue samples in the mid R17;90s. If he could find enough fragments of the virus he felt he might be able to decipher the genetic code and perhaps even resurrect the 1918 virus for study, the viral equivalent of bringing dinosaurs back to life in Jurassic Park.94 [114] He found remnants of two soldiers who succumbed to the 1918 flu on the same day in SeptemberR12;a 21-year-old private who died in South Carolina and a 30-year-old private who died in upstate New York. Tiny cubes of lung tissue preserved in wax were all that remained. TaubenbergerR17;s team shaved off microscopic sections and started hunting for the virus using the latest advances in modern molecular biology that he himself had helped devise. They found the virus, but only in tiny bits and pieces.95 [115] The influenza virus has eight gene segments, a genetic code less than 14,000 letters long (the human genome, in contrast, has several billion). The longest stands of RNA (the virusR17;s genetic material) that Taubenberger could find in the soldiersR17; tissue were only about 130 letters long. He needed more tissue.96 [116] The 1918 pandemic littered the Earth with millions of corpses. How hard could it be to find more samples? Unfortunately, refrigeration was essentially nonexistent in 1918, and common tissue preservatives like formaldehyde tended to destroy any trace of RNA.97 [117] He needed tissue samples frozen in time. Expeditions were sent north, searching for corpses frozen under the Arctic ice. Scientists needed to find corpses buried below the permafrost layer, the permanently frozen layer of subsoil beneath the topsoil, which itself may thaw in the summer.98 [118] Many teams over the years tried and failed. U.S. Army researchers excavated a mass grave near Nome, Alaska, for example, only to find skeletons.99 [119] R20;Lots of those people are buried in permafrost,R21; explained Professor John Oxford, co-author of two standard virology texts, R20;but many of them were eaten by the huskies after they died. Or,R21; he added, R20;before they died.R21;100 [120] On a remote Norwegian Island, Kirsty Duncan, a medical geographer from Canada, led the highest profile expedition in 1998, dragging 12 tons of equipment and a blue-ribbon academic team to the gravesite of seven coal miners who had succumbed to the 1918 flu.101 [121] Years of planning and research combined with surveys using ground-penetrating radar had led the team to believe that the bodies of the seven miners had been buried deep in the eternal permafrost.102 [122] Hunched over the unearthed coffins in biosecure space suits, the team soon realized their search was in vain.103 [123] The minersR17; naked bodies, wrapped only in newspaper, lay in shallow graves above the permafrost. Subjected to thawing and refreezing over the decades, the tissue was useless.104 [124] Nearly 50 years earlier, scientists from the University of Iowa, including a graduate student recently arrived from Sweden named Johan Hultin, had made a similar trek to Alaska with similarly disappointing results.105 [125] In the fall of 1918, the postal carrier delivered the mailR12;and the fluR12;via dogsled to a missionary station in Brevig, Alaska.106 [126] Within five days, 72 of the 80 or so missionaries lay dead.107 [127] With help from a nearby Army base, the remaining eight buried the dead in a mass grave.108 [128] Governor Thomas A. Riggs spent Alaska into bankruptcy caring for the orphaned children at Brevig and across the state. R20;I could not stand by and see our people dying like flies.R21;109 [129] Learning of TaubenbergerR17;s need for better tissue samples, Johan Hultin returned to Brevig a few weeks before his 73rd birthday.110 [130] Hultin has been described as R20;the Indiana Jones of the scientific set.R21;111 [131] In contrast to DuncanR17;s team, which spent six months just searching for the most experienced gravediggers, Hultin struck out alone.112 [132] Hultin was R20;there with a pickaxe,R21; one colleague relates. R20;He dug a pit though solid ice in three days. This guy is unbelievable. It was just fantastic.R21;113 [133] Among the many skeletons lay a young woman whose obesity insulated her internal organs. R20;She was lying on her back, and on her left and right were skeletons, yet she was amazingly well preserved. I sat on an upside-down pail, amid the icy pond water and the muck and fragrance of the grave,R21; Hultin told an interviewer, R20;and I thought, R16;HereR17;s where the virus will be found and shed light on the flu of 1918.R17;R21;114 [134] He named her Lucy. A few days later, Taubenberger received a plain brown box in the mail containing both of LucyR17;s lungs.115 [135] As Hultin had predicted, hidden inside was the key to unlock the mystery. Many had assumed that the 1918 virus came from pigs. Although the human influenza virus wasnR17;t even discovered until 1933, as early as 1919 an inspector with the U.S. Bureau of Animal Industry was publishing research that suggested a role for farm animals in the pandemic. Inspector J.S. Koen of Fort Dodge, Iowa wrote: The similarity of the epidemic among people and the epidemic among pigs was so close, the reports so frequent, that an outbreak in the family would be followed immediately by an outbreak among the hogs, and vice versa, as to present a most striking coincidence if not suggesting a close relation between the two conditions. It looked like R20;flu,R21; and until proven it was not R20;flu,R21; I shall stand by that diagnosis.116 [136] According to the editor of the medical journal Virology, KoenR17;s views were decidedly unpopular, especially among pig farmers who feared that customers R20;would be put off from eating pork if such an association was made.R21;117 [137] It was never clear, though, whether the pigs were the culprits or the victims. Did we infect the pigs or did they infect us? With the entire genome of the 1918 virus in hand thanks to HultinR17;s expedition, Taubenberger was finally able to definitively answer the Holy Grail question posed by virologists the world over throughout the century: Where did the 1918 virus come from? The answer, published in October 2005,118 [138] is that humanityR17;s greatest killer appeared to come from avian influenzaR12;bird flu.119 [139] Evidence now suggests that all pandemic influenza virusesR12;in fact all human and mammalian flu viruses in generalR12;owe their origins to avian influenza.120 [140] Back in 1918, schoolchildren jumped rope to a morbid little rhyme: I had a little bird, Its name was Enza. I opened the window, And in-flu-enza.121 [141] The children of 1918 may have been more prescient than anyone dared imagine. (c) BirdFluBook.com | Home [142] | Website by Lantern Media [143] Bird Flu - Resurrection BirdFluBook.com [144] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [145] Resurrection Dr. Taubenberger attempts to map out the 1918 virus Sequencing the 1918 virus is one thing; bringing it back to life is something else. Using a new technique called R20;reverse genetics,R21; Taubenberger teamed up with groups at Mount Sinai and the U.S. Centers for Disease Control and Prevention (CDC) and set out to raise it from the dead.122 [146] Using the genetic blueprint provided by LucyR17;s frozen lungs, they painstakingly recreated each of the genes of the virus, one letter at a time. Upon completion, they stitched each gene into a loop of genetically manipulated bacterial DNA and introduced the DNA loops into mammalian cells.123 [147] The 1918 virus was reborn. Ten vials of virus were created, each containing 10 million infectious virus particles.124 [148] First they tried infecting mice. All were dead in a matter of days. R20;The resurrected virus apparently hasnR17;t lost any of its kick,R21; Taubenberger noted. Compared to a typical non-lethal human flu strain, the 1918 virus generated 39,000 times more virus particles in the animalsR17; lungs. R20;I didnR17;t expect it to be as lethal as it was,R21; one of the co-authors of the study remarked.125 [149] The experiment was hailed as a R20;huge breakthrough,R21;126 [150] a R20;tour de force.R21;127 [151] R20;I canR17;t think of anything bigger thatR17;s happened in virology for many years,R21; cheered one leading scientist.128 [152] Not knowing the true identity of the 1918 flu had been R20;like a dark angel hovering over us.R21;129 [153] Critics within the scientific community, however, wondered whether the box Taubenberger had received from Hultin might just as well have been addressed to Pandora. One scientist compared the research to R20;looking for a gas leak with a lighted match.R21;130 [154] R20;They have constructed a virus,R21; one biosecurity specialist asserted, R20;that is perhaps the most effective bioweapon known.R21;131 [155] R20;This would be extremely dangerous should it escape, and there is a long history of things escaping,R21; warned a member of the Federation of American ScientistsR17; Working Group on Biological Weapons.132 [156] Taubenberger and his collaborators were criticized for using only an enhanced Biosafety Level 3 lab to resurrect the virus rather than the strictest height of security, Level 4. Critics cite three recent examples where deadly viruses had escaped accidentally from high-security labs.133 [157] In 2004, for example, a strain of influenza that killed a million people in 1957 was accidentally sent to thousands of labs around the globe within a routine testing kit. Upon learning of the error, the World Health Organization called for the immediate destruction of all the kits. Miraculously, none of the virus managed to escape any of the labs. Klaus Stohr, head of the World Health OrganizationR17;s global influenza program, admitted that it was fair to say that the laboratory accident with the unlabeled virus could have started a flu pandemic. R20;If many bad-luck things had come together, it could have really caused a global health emergency.R21;134 [158] R20;We canR17;t have this happen,R21; remarked Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota. R20;Who needs terrorists or Mother Nature, when through our own stupidity, we do things like this?R21;135 [159] Not only was the 1918 virus revived, risking an accidental release from the lab, but in the interest of promoting further scientific exploration, TaubenbergerR17;s group openly published the entire viral genome on the internet, letter for letter. This was intended to allow other scientists the opportunity to try to decipher the virusR17;s darkest secrets. The public release of the genetic code, however, meant that rogue nations or bioterrorist groups had been afforded the same access. R20;In an age of terrorism, in a time when a lot of folks have malicious intent toward us, I am very nervous about the publication of accurate [gene] sequences for these pathogens and the techniques for making them,R21; said a bioethicist at the University of Pennsylvania.136 [160] R20;Once the genetic sequence is publicly available,R21; explained a virologist at the National Institute for Biological Standards and Control, R20;thereR17;s a theoretical risk that any molecular biologist with sufficient knowledge could recreate this virus.R21;137 [161] Even if the 1918 virus were to escape, there might be a graver threat waiting in the wings. As devastating as the 1918 pandemic was, on average the mortality rate was less than 5%.138 [162] The H5N1 strain of bird flu virus now spreading like a plague across the world currently kills about 50% of its known human victims, on par with some strains of Ebola,139 [163] making it potentially ten times as deadly as the worst plague in human history.140 [164] ,141 [165] R20;The picture of what the [H5N1] virus can do to humans,R21; said the former chief of infectious disease at ChildrenR17;s Hospital in Boston, R20;is pretty gruesome in terms of its mortality.R21;142 [166] Leading public health authorities, from the U.S. Centers for Disease Control and Prevention to the World Health Organization, fear that this bird flu virus is but mutations away from spreading efficiently though the human population, triggering the next pandemic. R20;The lethal capacity of this virus is very, very high; so itR17;s a deadly virus that humans have not been exposed to before. ThatR17;s a very bad combination,R21; says Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University.143 [167] Scientists have speculated worst-case scenarios in which H5N1 could end up killing a billion144 [168] or more145 [169] people around the globe. R20;The only thing I can think of that could take a larger human death toll would be thermonuclear war,R21; said Council on Foreign Relations senior fellow Laurie Garrett.146 [170] H5N1 could potentially become a virus as ferocious as Ebola and as contagious as the common cold. (c) BirdFluBook.com | Home [171] | Website by Lantern Media [172] Bird Flu - Tiny Terrorists BirdFluBook.com [173] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [174] Tiny Terrorists Ebola virus If, as Nobel laureate Peter Medawar has said, a virus R20;is a piece of bad news wrapped in a protein,R21;147 [175] the world may have all the bad news it can handle with the emergence of the H5N1 virus. For more than a century, scientists have marveled at how a virus, one of the simplest, most marginal life forms, could present such a threat. R20;ItR17;s on the edge of life,R21; explains a former director of the CDCR17;s viral diseases division, R20;between living organism and pure chemicalR12;but it seems alive to me.R21;148 [176] For a virus, less is more. Viruses are measured in millionths of a millimeter.149 [177] As one writer described them, R20;Like tiny terrorists, viruses travel light, switch identity easily and pursue their goals with deadly determination.R21;150 [178] Viruses are simply pieces of genetic material, DNA or RNA, enclosed in a protective coat. As such, they face three challenges. First, they have genes, but no way to reproduce, so they must take over a living cell and parasitically hijack its molecular machinery for reproduction and energy production. The second problem viruses face is how to spread from one host to another. If the virus is too passive, it may not spread during the hostR17;s natural lifespan and thus will be buried with its host. The virus must not be too virulent, though. If a virus comes on too strong, it may kill its host before it has a chance to infect others, in which case the virus will also perish. Finally, all viruses need to be able to evade the hostR17;s defenses. Different viruses have found different strategies to accomplish each of these tasks.151 [179] (c) BirdFluBook.com | Home [180] | Website by Lantern Media [181] Bird Flu - R20;A hen is only an egg's way of making another egg.R21; BirdFluBook.com [182] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [183] R20;A hen is only an egg's way of making another egg.R21; R12;Samuel Butler Toxoplasma life cycle A virus is a set of instructions to make the proteins that allow it to spread and reproduce. Viruses have no legs, no wings, no way to move around. They even lack the whip-like appendages that many bacteria use for locomotion. So viruses must trick the host into doing the spreading for them. One sees similar situations throughout nature. Plants canR17;t walk from place to place, so many have evolved flowers with sweet nectar to attract bees who spread the plantsR17; reproductive pollen for them. Cockleburs have barbs to hitch rides on furry animals; berries developed sweetness so that birds would excrete seeds miles away. Viruses represent this evolutionary instinct boiled down to its essence. The rabies virus, for example, is programmed to infect parts of the animal brain that induce uncontrollable rage, while at the same time replicating in the salivary glands to spread itself best through the provoked frenzy of biting.152 [184] Toxoplasma, though not a virus, uses a similar mechanism to spread. The disease infects the intestines of cats, is excreted in the feces, and is then picked up by an intermediate hostR12;like a rat or mouseR12;who is eaten by another cat to complete the cycle. To facilitate its spread, the toxoplasma parasite worms its way into the rodentR17;s brain and actually alters the rodentR17;s behavior, amazingly turning the animalR17;s natural anti-predator aversion to cats into an imprudent attraction.153 [185] Diseases like cholera and rotavirus spread through feces, so, not surprisingly, they cause explosive diarrhea. Ebola is spread by blood, so it makes you bleed. Blood-borne travel is not very efficient, though. Neither is dog or even mosquito saliva, at least not for a virus that sets its sights high. Viruses that R20;figure outR21; how to travel the respiratory route, or the venereal route, have the potential to infect millions. Of the two, though, itR17;s easier to practice safe sex than it is to stop breathing. (c) BirdFluBook.com | Home [186] | Website by Lantern Media [187] Bird Flu - Something in the Air BirdFluBook.com [188] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [189] Something in the Air Influenza virus Viruses like influenza have only about a week to proliferate before the host kills them or, in extreme cases, they kill the host. During this contagious period there may be a natural selection toward viruses of greater virulence to overwhelm host defenses. Our bodies fight back with a triple firewall strategy to fend off viral attackers. The first is our set of barrier defenses. The outermost part of our skin is composed of 15 or more layers of dead cells bonded together with a fatty cement.154 [190] A new layer forms every day as dead cells are sloughed off, so about every two weeks, the entire layer is completely replaced.155 [191] Since viruses can only reproduce in live functional cells and the top layers of skin are dead, our intact skin represents a significant barrier to any viral infection. But the respiratory tract has no such protection. Not only is our respiratory tract lined with living tissue, it represents our primary point of contact with the external world. We only have about two square yards of skin, but the surface area within the convoluted inner passageways of our lungs exceeds that of a tennis court.156 [192] And every day we inhale more than 5,000 gallons of air.157 [193] For a virus, especially one not adapted to survive stomach acid, the lungs are the easy way in. Our bodies are well aware of these vulnerabilities. ItR17;s not enough for a virus to be inhaled; it must be able to physically infect a live cell. This is where mucus comes in. Our airways are covered with a layer of mucus that keeps viruses at armR17;s length from our cells. Many of the cells themselves are equipped with tiny sweeping hairs that brush the contaminated mucus up to the throat to be coughed up or swallowed into the killing acid of the stomach. One of the reasons smokers are especially susceptible to respiratory infections in general is that the toxins in cigarette smoke paralyze and destroy these fragile little sweeper cells.158 [194] Our respiratory tract produces a healthy half-cup of snot every day,159 [195] but can significantly ramp up production in the event of infection. Influenza viruses belong to the R20;orthomyxovirusR21; family, from the Greek orthos- myxa-, meaning R20;straight mucus.R21; The influenza virus found a way to cut through this barrier defense. Unlike most viruses, which have a consistent shape, influenza viruses may exist as round balls, spaghetti-like filaments, or any shape in between.160 [196] One characteristic they all share, though, is the presence of hundreds of spikes protruding from all over the surface of the virus, much like pins in a pincushion.161 [197] There are two types of spikes. One is a triangular, rod-shaped protein called hemagglutinin.162 [198] The other is a square, mushroom-shaped enzyme called neuraminidase. There have been multiple varieties of both enzymes described, so far 16 hemagglutinin (H1 to H16) and 9 neuraminidase (N1 to N9). Influenza strains are identified by which two surface enzymes they display. The strain identified as R20;H5N1R21; denotes that the virus is studded with the fifth hemagglutinin in the WHO-naming scheme, along with spikes of the first neuraminidase.163 [199] There is a reason the virus has neuraminidase jutting from its surface. Described by virologists as having a shape resembling a R20;strikingly long-stalked mushroom,R21;164 [200] this enzyme has the ability to slash through mucus like a machete, dissolving through the mucus layer to attack the respiratory cells underneath.165 [201] Then the hemagglutinin spikes take over. Hemagglutinin is the key the virus uses to get inside our cells. The external membrane that wraps each cell is studded with glycoproteinsR12;complexes of sugars and proteinsR12;that are used for a variety of functions, including cell-to-cell communication. The cells of our body are effectively sugar-coated. The viral hemagglutinin binds to one such sugar called sialic acid (from the Greek sialos for R20;salivaR21;) like Velcro hooks on a loop. In fact, thatR17;s how hemagglutinin got its name. If you mix the influenza virus with a sample of blood, the hundreds of surface hemagglutinin spikes on each viral particle form crosslinks between multiple sialic acid-covered red blood cells, effectively clumping them together. It agglutinates (glutinare or R20;to glueR21;) blood (heme-).166 [202] The docking maneuver prompts the cell to engulf the virus. Like some Saturday Night Live R20;landsharkR21; skit, the virus fools the cell into letting it inside. Once inside it takes over, turning the cell into a virus-producing factory. The conquest starts with the virus chopping up our own cellR17;s DNA and retooling the cell to switch over production to make more virus with a single-mindedness that eventually leads to the cellR17;s death through the neglect of its own needs.167 [203] Why has the virus evolved to kill the cell, to burn down its own factory? Why bite the hand that feeds it? Why not just hijack half of the cellR17;s protein-making capacity and keep the cell alive to make more virus? After all, the more cells that end up dying, the quicker the immune system is tipped off to the virusR17;s presence. The virus kills because killing is how the virus gets around. Influenza transmission is legendary. The dying cells in the respiratory tract trigger an inflammatory response, which triggers the cough reflex. The virus uses the bodyR17;s own defenses to infect others. Each cough releases billions of newly made viruses from the body at an ejection velocity exceeding 75 miles an hour.168 [204] Sneezes can exceed 100 miles per hour169 [205] and hurl germs as far away as 40 feet.170 [206] Furthermore, the viral neuraminidaseR17;s ability to liquefy mucus promotes the formation of tiny aerosolized droplets,171 [207] which are so light they can hang in the air for minutes before settling to the ground.172 [208] Each cough produces about 40,000 such droplets,173 [209] and each microdroplet can contain millions of viruses.174 [210] One can see how easily a virus like this could spread around the globe. In terms of viral strategy, another advantage of the respiratory tract is its tennis courtR11;sized surface area which allows the virus to go on killing cell after cell, thereby making massive quantities of virus without killing the host too quickly. The virus essentially turns our lungs into flu virus factories. In contrast, viruses that attack other vital organs like the liver can only multiply so fast without taking the host down with them.175 [211] Unlike some other viruses, like the herpes virus, which go out of their way not to kill cells so as not to incur our immune systemR17;s wrath, the influenza virus has no such option. It must kill to live, kill to spread. It must make us cough, and the more violently the better. (c) BirdFluBook.com | Home [212] | Website by Lantern Media [213] Bird Flu - Makings of a Killer BirdFluBook.com [214] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [215] Makings of a Killer NS1 protein binding to RNA The first line of our triple firewall against infection is our barrier defense. Once this wall is breached, we have to rely on an array of nonspecific defenses known as the R20;innateR21; arm of our immune system. These are typified by Pacman-like roving cells called macrophages (literally from the Greek for R20;big eatersR21;), which roam the body chewing up any pathogens they can catch. In this way, any viruses caught outside our cells can get gobbled up. Once viruses invade our cells, however, they are effectively hidden from our roaming defenses. This is where our interferon system comes in. Interferon is one of the bodyR17;s many cytokines, inflammatory messenger proteins produced by cells under attack that can warn neighboring cells of an impending viral assault.176 [216] Interferon acts as an early warning system, communicating the viral threat and activating in the cell a complex self-destruct mechanism should nearby cells find themselves infected. Interferon instructs cells to kill themselves at the first sign of infection and take the virus down with them. They should take one for the team and jump on a grenade to protect the rest of the body. This order is not taken lightly; false alarms could be devastating to the body. Interferon pulls the pin, but the cell doesnR17;t drop the grenade unless itR17;s absolutely sure itR17;s infected. This is how it works. When scientists sit down and try to create a new antibiotic (anti- bios, R20;against lifeR21;), they must find some difference to exploit between our living cells and the pathogen in question. ItR17;s like trying to formulate chemotherapy to kill the cancer cells but leave normal cells alone. There is no doubt that bleach and formaldehyde are supremely effective at destroying bacteria and viruses, but the reason we donR17;t chug them at the first sign of a cold is they are toxic to us as well. Most antibiotics, like penicillin, target the bacterial cell wall. Since animal cells donR17;t have cell walls, these drugs can wipe out bacteria and leave us still standing. Pathogenic fungi donR17;t have bacterial cell walls, but they do have unique fatty compounds in their cell membranes that our antifungals can target and destroy. Viruses have neither cell walls nor fungal compounds, and therefore these antibiotics and antifungals donR17;t work against viruses. ThereR17;s not much to a virus to single out and attack. ThereR17;s the viral RNA or DNA, of course, but thatR17;s the same genetic material as in our cells. Human DNA is double-stranded (the famous spiral R20;double helixR21;), whereas human RNA is predominantly single-stranded.177 [217] To copy its RNA genome to repackage into new viruses, the influenza virus carries along an enzyme that travels the length of the viral RNA to make a duplicate strand. For a split second, there are two intertwined RNA strands. ThatR17;s the bodyR17;s signal that something is awry. When a virus is detected, interferon tells neighboring cells to start making a suicide enzyme called PKR that shuts down all protein synthesis in the cell, stopping the virus, but also killing the cell in the process.178 [218] To start this deadly cascade, PKR must first be activated. PKR is activated by double-stranded RNA.179 [219] What interferon does is prime the cells of the body for viral attack. Cells preemptively build up PKR to be ready for the virus. An ever-vigilant sentry, PKR continuously scans cells for the presence of double-stranded RNA. As soon as the PKR detects that characteristic signal of viral invasion, the PKR kills the cell and hopes to take down the virus with it. Our cells die, but they go down fighting. This defense strategy is so effective in blunting a viral onslaught that biotech companies are now trying to genetically engineer double-stranded RNA to be taken in pill form during a viral attack in hopes of accelerating this process.180 [220] Cytokines like interferon have beneficial systemic actions as well. Interferon release leads to many of the other symptoms we associate with the flu, such as high fever, fatigue, and muscle aches.181 [221] The fever is valuable since viruses like influenza tend to replicate poorly at high temperatures. Some like it hot, but not the influenza virus. The achy malaise encourages us to rest so our bodies can shift energies to mounting a more effective immune response.182 [222] On a population level, these intentional side effects may also limit the spread of the virus by limiting the spread of the host, who may feel too lousy to go out and socialize. Cytokine side effects are our bodyR17;s way of telling us to call in sick. Normally when you pretreat cells in the lab with powerful antivirals like interferon, the cells are forewarned and forearmed, and viral replication is effectively blocked.183 [223] Not so with H5N1, the deadly bird flu virus spreading out of Asia. Somehow this new influenza threat is counteracting the bodyR17;s antiviral defenses, but how? Viruses have evolved a blinding array of ways to counter our bodyR17;s finest attempts at control. The smallpox virus, for example, actually produces what are called R20;decoy receptorsR21; to bind up the bodyR17;s cytokines so that less of them make it out to other cells.184 [224] R20;I am in awe of these minute creatures,R21; declared a Stanford microbiologist. R20;They know more about the biology of the human cell than most cell biologists. They know how to tweak it and how to exploit it.R21;185 [225] How does H5N1 block interferonR17;s interference? After all, the virus canR17;t stop replicating its RNA. The H5N1 virus carries a trick up its sleeve called NS1 (for R20;Non-StructuralR21; protein). If interferon is the bodyR17;s antiviral warhead, then the NS1 protein is the H5N1R17;s antiballistic missile.186 [226] NS1 itself binds to the virusR17;s own double-stranded RNA, effectively hiding it from the cellR17;s PKR cyanide pill, preventing activation of the self-destruct sequence. Interferon can pull the pin, but the cell canR17;t let go of the grenade. NS1 essentially foils the bodyR17;s attempt by covering up the virusR17;s tracks. Influenza viruses have been called a R20;showcase for viral cleverness.R21;187 [227] All influenza viruses have NS1 proteins, but H5N1 carries a mutated NS1 with enhanced interferon-blocking abilities. The H5N1R17;s viral countermove isnR17;t perfect. The virus just needs to buy itself enough time to spew out new virus. Then it doesnR17;t care if the cell goes down in flamesR12;in fact, the virus prefers it, because the cellR17;s death may trigger more coughing. R20;This is a really nasty trick that this virus has learnt: to bypass all the innate mechanisms that cells have for shutting down the virus,R21; laments the chief researcher who first unearthed H5N1R17;s deadly secret. R20;It is the first time this mechanism has shown up and we wonder if it was not a similar mechanism that made the 1918 influenza virus so enormously pathogenic.R21;188 [228] Now that researchers actually had the 1918 virus in hand, it was one of the first things they tested in hopes of understanding why the apocalyptic pandemic was so extraordinarily deadly. They tested the virus in a tissue culture of human lung cells, and, indeed, the 1918 virus was using the same NS1 trick to undermine the interferon system.189 [229] As the University of MinnesotaR17;s Osterholm told Oprah Winfrey, H5N1 is a R20;kissing cousin of the 1918 virus.R21;190 [230] H5N1 may come to mean 1918 all over again. (c) BirdFluBook.com | Home [231] | Website by Lantern Media [232] Bird Flu - R20;But what gave this pestilence particularly severe force was that whenever the diseased mixed with healthy people, like a fire through dry grass or oil, it would run upon the healthy.R21; BirdFluBook.com [233] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [234] R20;But what gave this pestilence particularly severe force was that whenever the diseased mixed with healthy people, like a fire through dry grass or oil, it would run upon the healthy.R21; R12;BoccaccioR17;s description of the plague in Florence in his classic Decameron, published in 1350191 [235] 1918 deaths peaked among young adults H5N1 shares another ominous trait with the virus of 1918: They both have a taste for the young. One of the greatest mysteries of the 1918 pandemic was, in the words of then Acting Surgeon General of the Army, why R20;the infection, like war, kills the young vigorous robust adults.R21;192 [236] As the American Public Health Association put it rather crudely at the time: R20;The major portion of this mortality occurred between the ages of 20 and 40, when human life is of the highest economic importance.R21;193 [237] Seasonal influenza, on the other hand, tends to seriously harm only the very young or the very old. The death of the respiratory lining that triggers fits of coughing accounts for the sore throat and hoarseness that typically accompany the illness. The mucus-sweeping cells are also killed, which opens up the body for a superimposed bacterial infection on top of the viral infection. This bacterial pneumonia is typically how stricken infants and elderly may die during flu season every year. Their immature or declining immune systems are unable to fend off the infections in time. The resurrection of the 1918 virus offered a chance to solve the great mystery. The reason the healthiest people were the most at risk, researchers discovered, was that the virus tricked the body into attacking itselfR12;it used our own immune systems against us. Those who suffer anaphylactic reactions to bee stings or food allergies know the power of the human immune system. In their case, exposure to certain foreign stimuli can trigger a massive overreaction of the bodyR17;s immune system that, without treatment, could literally drop them dead within minutes. Our immune systems are equipped to explode at any moment, but there are layers of fail-safe mechanisms that protect most people from such an overreaction. The influenza virus has learned, though, how to flick off the safety. Both the 1918 virus and the current threat, H5N1, seem to trigger a R20;cytokine storm,R21; an overexuberant immune reaction to the virus. In laboratory cultures of human lung tissue, infection with the H5N1 virus led to the production of ten times the level of cytokines induced by regular seasonal flu viruses.194 [238] The chemical messengers trigger a massive inflammatory reaction in the lungs. R20;ItR17;s kind of like inviting in trucks full of dynamite,R21; says the lead researcher who first discovered the phenomenon with H5N1.195 [239] While cytokines are vital to antiviral defense, the virus may trigger too much of a good thing.196 [240] The flood of cytokines overstimulates immune components like Natural Killer Cells, which go on a killing spree, causing so much collateral damage that the lungs start filling up with fluid. R20;It actually turns your immune system on its head, and it causes that part to be the thing that kills you,R21; explains Osterholm.197 [241] R20;All these cytokines get produced and [that] calls in every immune cell possible to attack yourself. ItR17;s how people die so quickly. In 24 to 36 hours, their lungs just become bloody rags.R21;198 [242] People between 20 and 40 years of age tend to have the strongest immune systems. You spend the first 20 years of your life building up your immune system, and then, starting around age 40, the systemR17;s strength begins to wane. That is why this age range is particularly vulnerable, because itR17;s your own immune system that may kill you.199 [243] A new dog learning old tricks, H5N1 may be following in the 1918 virusR17;s footsteps.200 [244] Either we wipe out the virus within days or the virus wipes out us. The virus doesnR17;t care either way. By the time the host wins or dies, it expects to have moved on to virgin territoryR12;and in a dying host, the cytokine storm may even produce a few final spasms of coughing, allowing the virus to jump the burning ship. As one biologist recounted, the bodyR17;s desperate shotgun approach to defending against infection is R20;somewhat like trying to kill a mosquito with a macheteR12;you may kill that mosquito, but most of the blood on the floor will be yours.R21;201 [245] (c) BirdFluBook.com | Home [246] | Website by Lantern Media [247] Bird Flu - R20;There is nothing permanent except change.R21; BirdFluBook.com [248] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [249] R20;There is nothing permanent except change.R21; R12;Heraclitus Mutant swarm of influenza viruses The final wall of defense, after barrier methods and the best attempts of the innate immune system have failed, is the R20;adaptiveR21; (or R20;acquiredR21;) arm of the immune system: the ability to make antibodies. Antibodies are like laser-guided missiles specific for a particular foreign invader. They are made by immune cells called R20;B cellsR21; that arise in our bone marrow. We make a billion of these cells every day of our lives, each recognizing a specific target. Once one of these B cells is activated, it can pump out thousands of antibodies a second.202 [250] And some of them remember. So-called R20;Memory B cellsR21; retain a memory of past invaders and lie in wait for a repeat attack. If that same invader ever tried anything again, the body would be armed and ready to fight it off before it could gain a foothold. This is why once you get chicken pox, you tend never to get it again. Our adaptive immune system is the principle behind vaccination. People can get vaccinated against measles as infants, for example, setting in place a R20;memoryR21; of the virus, and retain immunity for life. Why can you get a few shots against something like mumps as a kid and forget about it, whereas thereR17;s a new flu vaccine out every year? Because the influenza virus, in the words of the World Health Organization, is a R20;Master of Metamorphosis.R21;203 [251] Influenza viruses are like Hannibal Lecter. They bud from infected cells and cloak themselves in a stolen swatch of the cellR17;s own membrane, wrapping itself in our cellsR17; own skin as a disguise. The virus canR17;t completely hide, though. Out of necessity it must poke neuraminidase and hemagglutinin spikes through the membrane to clear through mucus and bind to new cells. These are the primary targets, then, that our antibodies go after. So that it doesnR17;t go the way of chicken pox, the influenza virusR17;s only chance for reinfection is to stay one step ahead of our antibodies by presenting an ever-moving target. The World Health Organization describes influenza viruses as R20;sloppy, capricious, and promiscuous.R21;204 [252] Sloppy, because an RNA virus thrives on mutation. The human genetic code is billions of DNA letters long. Every time one of our cells divides, each of those letters has to be painstakingly copied to provide each progenitor cell with the identical genetic complement. This is a tightly controlled process to prevent the accumulation of mutations (errors) in our genetic code. RNA replication is different. RNA viruses have no spell-checker, no proofreading mechanism.205 [253] A virus like influenza is no perfectionist. When RNA viruses make copies of their genomes, they R20;intentionallyR21; include mistakes, so odds are that each new virus is unique.206 [254] Once a cell is infected and its molecular machinery pirated, it starts spewing out millions of viral progeny, each a bit different from the next, a population of viruses known in the scientific world as a R20;mutant swarm.R21;207 [255] Essentially, every virus is a mutant.208 [256] Most of the new viruses are so mutated, so crippled that they wonR17;t survive to reproduce, but thousands of the fittest will.209 [257] This represents millennia of evolution by the hour. This is how other RNA viruses like HIV and hepatitis C can exist for years within the same individual; they are constantly changing, constantly evading the immune system.210 [258] One of the reasons we havenR17;t been able to come up with a vaccine against HIV is that it mutates so rapidly211 [259] R12;and the influenza virus mutates even faster.212 [260] This is why itR17;s so hard for our immune system to get a handle on influenza. By the time weR17;ve mounted an effective antibody response, the virus has changed appearances ever so slightly, a process called genetic R20;drift.R21; ThatR17;s why influenza can come back year after year. Professor Kennedy Shortridge, the virologist who first identified H5N1 in Hong KongR17;s chickens, describes influenza as being caused by an R20;unintelligent, unstable virus.R21;213 [261] A fellow colleague put it bluntly: R20;FluR17;s not clever. Forget this idea that the virus is clever. The virus is clumsy. It makes lots of mistakes when itR17;s copying itself, the ones that have an advantage get selected, and thatR17;s why itR17;s successful.R21;214 [262] No other human respiratory virus has this kind of mutation rate.215 [263] ItR17;s like the worst of all worlds: respiratory spread of a deadly virus with a high mutation rate. Scientists fear H5N1 could become like an airborne HIVR12;half the mortality rate of HIV, but able to kill within days. (c) BirdFluBook.com | Home [264] | Website by Lantern Media [265] Bird Flu - Viral Sex BirdFluBook.com [266] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [267] Viral Sex Genetic drift and shift (reassortment) The few genes the influenza virus has are distributed among eight discrete strands of RNA within each virus. It must be a nightmare for the virus to package each new outgoing progenitor with the correct RNA octet. Why not just keep all its genes on a single strand? Because with separate strands, influenza viruses can have sex.216 [268] Variability is the engine of evolution. Survival of the fittest only works if there are some more fit than others and some less so. That is how natural selection worksR12;how, over time, species can adjust to unpredictable changes in their environment. If all progeny are identical, if all progeny are simply clones of the parent, then the species has less flexibility to adapt. This is thought to be why the birds and the bees evolved to combine genetic endowments with one another in order to reproduce. This genetic mixing greatly increases variation among the offspring. Suppose two completely different types of influenza viruses take over the same cell. They each make millions of copies of their eight individual RNA strands. Then what happens? As each new progeny virus buds from the cell, it can mix and match genes from both R20;parents.R21; This segmented nature of the genome allows different flu viruses to easily R20;mateR21; with each other, swapping segments of RNA to form totally new hybrid viruses.217 [269] This is one way pandemics can be made. Only one strain of influenza tends to dominate at any one time within the human population.218 [270] Since 1968 that strain has been H3N2. Each year, the virusR17;s protruding spikes drift subtly in appearance, but the virus is still H3N2, so antibodies we made against the virus in previous years still recognize it as somewhat familiar and confer us some protection. As such, year after year for decades now, H3N2 has been kept in check by our immune systems thanks to our prior run-ins with the virus. If the virus didnR17;t change its appearance at all from year to year, our immunity could be absolute, and like chicken pox weR17;d never get the flu again. Because the appearance of the virus does drift a bit annually, every year some of us do come down with the flu. For most of us, though, the illness only lasts a few days before our prior partial immunity can vanquish the familiar foe and we can get on with our lives. Pandemics happen when a dramatically different virus arrives on the scene, an influenza virus to which we have no prior immunity. This can happen when the virus undergoes an entire R20;shift,R21; acquiring a new H spike. This is where gene swapping can come in. The 1918 pandemic virus was H1N1. It came back in subsequent years, but by then it was old hat. Those who had survived the virus during the pandemic retained much immunity. The annual flu strain remained H1N1, infecting relatively few people every year for decades until 1957, when an H2N2 virus suddenly appeared as the R20;Asian fluR21; pandemic of 1957. Because the worldR17;s population had essentially only acquired immunity to H1 spikes, the virus raced around the globe, infecting a significant portion of the worldR17;s population. For example, half of U.S. schoolchildren fell ill.219 [271] Thankfully, it was not very virulent and only killed about a million people worldwide.220 [272] H2N2 held seasonal sway for 11 years. In 1968, the H3N2 R20;Hong Kong FluR21; virus triggered what is generally considered the last pandemic and has been with us every year ever since. It attacked even fewer people than the H2N2 fluR12;only about 40% of U.S. adolescents got sickR12;and killed fewer still. Experts suspect that partial immunity to at least the N2 spike afforded a baseline level of protection.221 [273] Since 95% of the surface spikes are hemagglutinin and only 5% are neuraminidase,222 [274] though, and the hemagglutinin directly determines infectivity, it is the appearance of a new H spike that triggers a pandemic.223 [275] If only one type of human virus dominates at one time, with which viruses can the dominant virus swap genes? Birds are the reservoir from which all human and nonhuman animal influenza genes originate. Pandemic viruses can arise when human influenza dips into the bird flu gene pool and pulls out some avian H or N combination that the present human generation has never seen before. The human virus has lots to choose from, since birds harbor 16 different hemagglutinin spikes and 9 different spikes of neuraminidase.224 [276] Researchers speculate that sometime shortly before February 1957, somewhere along the road between Kutsing and Kweiyang in southern China, an H2N2 bird flu virus may have infected either a pig or a person already suffering from the regular H1N1 seasonal human flu, and an unholy viral matrimony took place.225 [277] From one of those co-infected cells came a human-bird crossbreed virus containing five of the original human viral gene segments and three new segments from the bird virus, including the new H and the new N spikes.226 [278] Then, in 1968, the virus swapped its H2 for an H3 from another bird flu strain. With each new avian addition, the virus became sufficiently alien to the human immune system to quickly blanket the globe. So there were three influenza pandemics in the 20th centuryR12;in 1918, 1957, and 1968R12;but, as the director of the National Institute for Allergy and Infectious Diseases has said, R20;There are pandemics and then there are pandemics.R21;227 [279] The half-and-half bird/human hybrid viruses of 1957 and 1968 evidently contained enough previously recognizable human structure that the human populationR17;s prior partial exposure dampened the pandemicR17;s potential to do harm. But the pandemic strain of 1918 was wholly avian-like.228 [280] Instead of diluting its alien avian nature, the 1918 bird flu virus, as TaubenbergerR12;the man who helped resurrect itR12;notes, R20;likely jumped straight to humans and began killing them.R21;229 [281] The same could be happening with H5N1. The human immune system has never been known to be exposed to an H5 virus before. As the WHO points out, R20;Population vulnerability to an H5N1-like pandemic virus would be universal.R21;230 [282] H5N1 has developed a level of human lethality not thought possible for influenza. Half of those known to have come down with this flu so far have died.231 [283] H5N1 is good at killing, but not at spreading. To trigger a pandemic, the virus has to learn how to spread efficiently from person to person. Now that the genome of the 1918 virus has been completely sequenced, we understand that it may have taken only a few dozen mutations to turn a bird flu virus into humanityR17;s greatest killer.232 [284] Already we see in H5N1 some of those changes taking form.233 [285] The further H5N1 spreads and the more people it infects, the greater the likelihood that it might lock in mutations that could allow for efficient human-to-human transmission. R20;And thatR17;s what keeps us up at night,R21; said the chair of the Infectious Diseases Society of AmericaR17;s task force on pandemic influenza.234 [286] R20;ItR17;s like a frequent flyer program,R21; explains another flu expert. R20;Take enough trips and you can go anywhere.R21;235 [287] Recent research funded by the National Institutes of Health (NIH) suggests that influenza viruses mutate even faster than previously thought.236 [288] Some scientists theorize the existence of a R20;mutator mutationR21; that makes replication even sloppier, predisposing the virus for the species jump.237 [289] As if its sloppiness and segmentation donR17;t create enough novelty for our immune system, influenza viruses have devised a third way to mutate. The process of swapping genes between two viruses has been named R20;reassortment,R21; like reshuffling two decks of cardsR12;one human deck, one bird deck, with eight cards each. A process now known as R20;recombinationR21; allows influenza viruses to swap mere pieces of individual RNA strands with each other. ItR17;s as if the virus not only reshuffles both decks together, but also cuts each card in half and then randomly tapes the halves back together.238 [290] Masters of metamorphosis indeed. All influenza viruses are capable of high rates of mutation, but never has the scientific world seen a virus like H5N1. Very few human pathogens even approach 50% mortality. The director of the Center for Biosecurity of the University of Pittsburgh recently noted this at a congressional briefing: R20;Death rates approaching this order of magnitude are unprecedented for any epidemic disease.R21; University of MinnesotaR17;s Osterholm describes the spectre of a deadly superflu as R20;the beast lurking in the midnight of every epidemiologistR17;s soulR21;R12;the R20;Ace of Spades in the influenza deck.R21;239 [291] Robert Webster, chair of the Virology Division of St. Jude ChildrenR17;s Research Hospital in Tennessee, is arguably the worldR17;s top bird flu expert. He is often referred to as the R20;popeR21; of influenza researchers.240 [292] In characteristically unpapal language, Webster puts it bluntly. H5N1, he said, is R20;the one that scares us shitless.R21;241 [293] (c) BirdFluBook.com | Home [294] | Website by Lantern Media [295] Bird Flu - Hong Kong, 1997 BirdFluBook.com [296] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [297] Hong Kong, 1997 Young boy killed by H5N1 It all seemed to start with a three-year-old boy in Hong Kong with a sore throat and tummy ache.242 [298] On May 14, 1997, Lam Hoi-ka was admitted to Queen Elizabeth Hospital with a fever; a week later he was dead. The causes of death listed were acute respiratory failure, acute liver failure, acute kidney failure, and R20;disseminated intravascular coagulopathy.R21; Basically, on top of the multiple organ failure, his blood had curdled.243 [299] The top specialist of the government virus unit was called in.244 [300] Samples were taken from the boyR17;s throat. As far as anyone knew, human beings were susceptible to getting sick only from H1, H2, and H3 viruses. When the samples came back positive for influenza, but negative for all known human strains, Hong KongR17;s chief virologist forwarded the mystery samples to the worldR17;s top labs in London, Holland, and the CDC in Atlanta.245 [301] The Dutch were the first to make the discovery. Virologist Jan de Jong received the sample and passed it to the lab of a colleague, Albert Osterhaus. That team found that the boy had been killed by an H5 virus, H5N1.246 [302] The scientific world was stunned. R20;We thought we knew the rules,R21; recalls the director of the Center for Public Health Preparedness at Columbia University, R20;and one of those rules was that H1, H2 and H3 cause flu in humans, not H5. This is like the clock striking 13.R21;247 [303] H5 was supposed to cause disease only in birds, not in people. Within two days, de Jong was on a plane to Hong Kong. R20;We had to act very, very quickly,R21; he recalls. R20;We realized this could be a pandemic situation.R21;248 [304] Keiji Fukuda, chief of epidemiology in the CDCR17;s influenza branch, followed shortly behind. When Fukuda arrived in Hong Kong, he scoured through the dead boyR17;s medical charts. R20;As I went over his chart, the case became very un-abstract,R21; he said. It had been a hard death. The child had had to have a breathing tube inserted and was reportedly in great pain. Fukuda at the time was the father of two young children. R20;It drove home for me how much suffering there might be if this bug took off.R21;249 [305] If H5N1 had spread from Hong Kong in 1997, Lam Hoi-ka would have been Patient Zero for a new global pandemic.250 [306] Keiji Fukuda was asked in an interview years later what his first thought had been upon hearing the news that an H5 virus had killed a child. He said that he distinctly remembered hanging up the phone and thinking, R20;This is how it begins.R21;251 [307] What this first death showed, according to the director of HollandR17;s National Influenza Center, R20;was what everyone until then had thought impossibleR12;that the virus could leap directly from birds to humans.R21;252 [308] R20;This had never happened before in history,R21; agreed the head of the University of Hong KongR17;s Emerging Pathogens Group. R20;It was terrifying.R21; These statements were taken before the 1918 virus was resurrected in 2005.253 [309] It had happened before in history, many scientists now believe, in 1918R12;and that makes it all the more terrifying. (c) BirdFluBook.com | Home [310] | Website by Lantern Media [311] Bird Flu - Fowl Plague BirdFluBook.com [312] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [313] Fowl Plague Highly pathogenic avian influenza More than a century ago, researchers confirmed the first outbreak of a particularly lethal form of avian influenza that they called R20;fowl plague.R21;254 [314] Plague comes from the Greek word meaning R20;blowR21; or R20;strike.R21;255 [315] Later, the name R20;fowl plagueR21; was abandoned and replaced by R20;highly pathogenic avian influenza,R21; or HPAI.256 [316] Highly pathogenic avian influenza viruses start out as low-grade viruses, so-called R20;low pathogenic avian influenza,R21; or LPAI, which may cause a few ruffled feathers and a drop in egg production.257 [317] Low-grade viruses with H5 or H7 spikes are able to mutate into the high-grade variety that can cause devastating illness among the birds. WebsterR17;s term for H5 and H7 strains of flu says it all: R20;the nasty bastards.R21;258 [318] And you donR17;t get nastier than H5. Besides his role as R20;Pope of Bird Flu,R21;259 [319] Webster is the director of the U.S. Collaborating Center of the World Health Organization.260 [320] Webster is credited as the one who first discovered the part avian influenza plays in triggering all known human pandemics. The Washington Post described him as R20;arguably the worldR17;s most important eye on animal influenza viruses.R21;261 [321] Webster had more reason than most to be especially concerned about the death in Hong Kong. He had seen H5 before; he knew what it could do. In 1983, an H5N2 virus struck commercial chicken operations in Pennsylvania. It quickly became the worldR17;s largest outbreak of avian influenza and the most costly animal disease control operation in U.S. history.262 [322] Seventeen million chickens died or had to be killed. As striking as the numbers of deaths were, it was the way the chickens died that continues to haunt scientists. In the veterinary textbooks, the deaths are described as R20;a variety of congestive hemorrhagic, transudative and necrobiotic changes.R21;263 [323] One researcher described it in lay terms: The chickens were essentially reduced to R20;bloody Jell-O.R21;264 [324] In the spring of 1997, two months before Lam Hoi-ka fell ill, the same thing started happening in Hong Kong. Thousands of chickens were dying from H5N1. R20;Their bodies began shaking,R21; one farmer described, R20;as if they were suffocating and thick saliva starting coming out of their mouths. We tried to give the hens herbs to make them better, but it made no difference. The faces then went dark green and black, and then they died.R21;265 [325] Some of the birds were asphyxiating on large blood clots lodged in their windpipes.266 [326] R20;One minute they were flapping their wings,R21; another reported, R20;the next they were dead.R21;267 [327] Others had given birth to eggs without shells.268 [328] In the lab, the virus was shown to be a thousand-fold more infectious than typical human strains.269 [329] The virus, one Hong Kong scientist remarked, R20;was like an alien.R21;270 [330] Kennedy Shortridge, then chair of the University of Hong KongR17;s Department of Microbiology, went personally to investigate. Growing up in Australia, Shortridge was shaken by his motherR17;s haunting stories of the 1918 pandemic and decided to dedicate his life to trying to understand the origins of influenza pandemics.271 [331] He had already been working 25 years on this question in Hong Kong before H5N1 hit. He found R20;chickens literally dying before our eyes.R21;272 [332] R20;One moment, birds happily pecked their grain,R21; he recalls, R20;the next, they fell sideways in slow motion, gasping for breath with blood slowly oozing from their guts.R21;273 [333] On necropsy, pathologists found that the virus had reduced the birdsR17; internal organs to a bloody pulp. R20;We were looking at a chicken Ebola,R21; Shortridge recalls.274 [334] R20;I had never seen anything like it.R21;275 [335] R20;It was an unbelievable situation, totally frightening. My mind just raced,R21; he remembers. R20;I thought, R16;My God. What if this virus were to get out of this market and spread elsewhere?R17;R21;276 [336] (c) BirdFluBook.com | Home [337] | Website by Lantern Media [338] Bird Flu - Close Call BirdFluBook.com [339] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [340] Close Call Hong Kong cull The second human to die in Hong Kong was a 13-year-old girl with a headache. She soon started coughing blood as her lungs began hemorrhaging. The internal bleeding spread to her intestinal tract, and then her kidneys shut down.277 [341] She fought for weeks on a ventilator before she died. R20;To me,R21; remarked Webster, R20;the startling thing about the second case is that there is a second case.R21; The experts still couldnR17;t believe that a virus supposed to be R20;strictly for the birdsR21; was directly attacking human children.278 [342] These initial cases started with typical flu symptomsR12;fever, headache, malaise, muscle aches, sore throat, cough, and a runny nose. They werenR17;t dying of a superimposed bacterial pneumonia, as one tends to see in seasonal influenza deaths of the elderly and infirm. H5N1 seemed to have gotten the immune system to do the dirty work. Autopsies were performed on two of the first six victims, the 13-year-old girl in Hong Kong and a 25-year-old Filipino woman. Both died of multiple organ failure. Their lungs were filled with blood, their livers and kidneys clogged with dead tissue, and their brains swollen with fluid.279 [343] In both cases, cytokine levels were found to be elevated. The virus evidently had tricked the body into unleashing cytokine storms, burning their livers, kidneys, and lungs in their immune systemsR17; not-so-friendly fire. Interestingly, viral cultures taken at autopsy from all their organs came up negative. It seems that in their bodiesR17; brutal counter-attack, their immune systems were able to triumph in a way and kill off the virus. Of course, in burning down the village in order to save it, the patients were killed off as well.280 [344] Most of the 1997 victims had either bought chickens (or, in one case, chicken feet) or had shopped next door to a chicken merchant.281 [345] Lam Hoi-ka may have been infected by baby birds in his preschoolR17;s R20;feathered pet corner.R21;282 [346] The strongest risk factor to shake out of the subsequent investigations was R20;either direct or indirect contact with commercial poultry.R21;283 [347] Human-to-human transmission remained very limited. An infected banker, for example, didnR17;t pass the virus on to coworkers, but when a two-year-old boy had R20;played with and been hugged and kissed by his symptomatic 5-year old female cousin,R21; he joined her in the hospital three days later.284 [348] Thankfully, they both recovered. The virus seemed only to be spread by close, rather than casual, contact. One of Lam Hoi-kaR17;s doctors came up positive for the virus, for example, but it is believed she had come in contact with his tears.285 [349] The virus was still learning, but the scientific community was bent on putting an end to its education. Realizing the disease was coming from chickens, leading scientists called for every chicken in the entire territory to be killed at once to stop any and all new human cases. R20;The infection was obviously tearing away at the inside of the birds,R21; Shortridge realized. R20;My reaction was: R16;This virus must not escape from Hong Kong.R17;R21;286 [350] Biologically the plan made sense, but politically it was a tough sell. R20;It was absolutely terrifying.R21; Shortridge remembers. R20;You could feel the weight of the world pressing down on you.R21;287 [351] The weight of world opinion may indeed have been what finally led to the governmentR17;s concession. Hong Kong had just been reunified with China, and with eyes focused on the fledgling power, it could not afford to be perceived as endangering the rest of the world.288 [352] Amid mounting panic, Margaret F. C. Chan, who would go on to lead the investigation into SARS and become the World Health OrganizationR17;s influenza chief, ordered death sentences for more than a million birds.289 [353] For four days, hundreds of Hong KongR17;s government employeesR12;many of them desk workersR12;engaged in the slaughter.290 [354] Scuffles broke out with chicken vendors. Buddhist monks held a seven-day prayer chant for the souls of the birds.291 [355] Overnight, new human infections ceased. The last human case in the 1997 Hong Kong outbreak was recognized the day before the slaughter commenced.292 [356] In all, only 18 people got sick and only 6 people died. R20;I remember it as the most satisfying investigation of my life,R21; Fukuda said.293 [357] His own children, half way around the world, were safe now, too. (c) BirdFluBook.com | Home [358] | Website by Lantern Media [359] Bird Flu - R20;Next to a battle lost, the greatest misery is a battle gained.R21; BirdFluBook.com [360] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [361] R20;Next to a battle lost, the greatest misery is a battle gained.R21; R12;Duke of Wellington Dr. Robert Webster Books have been written about the 1997 outbreak. Noted journalist Pete Davies was with Webster eight months after the mass slaughter, perched on an Arctic mountainside within miles of the North Pole. He asked Webster if they had done the right thing killing all those chickens in Hong Kong. R20;It was a killerR12;like 1918 on its way,R21; Webster replied.294 [362] If the chickens hadnR17;t been killed, R20;I would predict that you and I would not be sitting here talking now. Because one of us would be dead.R21;295 [363] Other experts agree. R20;Imagine if that virus obtained a little additional capacity to be freely transmitted in humans,R21; said Klaus Stohr, head of the World Health OrganizationR17;s influenza program, R20;a large proportion of the population of the world would presumably have died.R21;296 [364] Fukuda explains: R20;When you look at the people who diedR30;[most] were basically healthy young adults. These are not the kinds of people you normally see dying from influenzaR30;and most of them died from illnesses generally consistent with viral pneumoniaR12;so itR17;s very similar to the picture we saw in 1918. ItR17;s disturbingly similarR12;and thatR17;s what gave this added sick feeling in all our stomachs.R21;297 [365] The Hong Kong government took heat from the poultry industry for its decision to kill more than a million birds, but was vindicated by a 1998 joint proclamation signed by 19 of the worldR17;s experts on influenza, including the World Health OrganizationR17;s chief authority, expressing gratitude for Hong KongR17;s decision. The proclamation concluded: R20;We may owe our very lives to their actions.R21;298 [366] Only years later did intensive research on the H5N1 virus reveal how close the world had truly come to facing a pandemic. There was evidence that during the Hong Kong crisis the virus was rapidly adapting to the new human host, acquiring mutations that increased its ability to replicate in human tissue. The University of Hong KongR17;s Kennedy Shortridge wrote in 2000, R20;It is probably fair to say that a pandemic had been averted.R21;299 [367] The Hong Kong Medical AssociationR17;s infectious disease expert, however, warned that this may not have been the end to H5N1. R20;And as long as we have the circumstances which can favour the spread of H5N1,R21; he said, R20;it can occur again.R21;300 [368] The CDCR17;s Keiji Fukuda was asked in an interview whether the prospect of H5N1R17;s return robbed him of any sleep. R20;More nights than I like,R21; he admitted.301 [369] Closely studying the Hong Kong H5N1 virus, Webster estimated that it may have taken only months for it R20;to acquire whatever mutations are needed for transmitting between peopleR12;but it would have done it,R21; he said. R20;And if it had got away, my GodR30;. I am convinced that this virus was probably like 1918. It was wholly avian, yesR12;but it had human aspects that weR17;ve never seen before.R21;302 [370] Now we suspect the 1918 virus was wholly avian as well, a R20;human adapted variant of a pathogenic avian strain.R21;303 [371] Mike Ryan, coordinator of the Global Outbreak Alert and Response Network at the World Health Organization, describes H5N1 in birds as R20;a disease of biblical proportion.R21;304 [372] Webster thought about the horrific deaths of the children of Hong Kong. R20;How many people have immunity to H5?R21; Webster asked rhetorically. R20;Zippo.R21;305 [373] R20;The chicken population in Pennsylvania [in 1983] is like the world as it is in this moment,R21; Webster said. R20;There are millions of us R16;chickensR17; just waiting to be infected.R21;306 [374] In a textbook published by Oxford University, Webster wrote this about the Pennsylvania H5 outbreak in 1983: How do we cope with such an epidemic? The Agriculture Department used the standard methods of eradication, killing the infected chickens and exposed neighboring birds and burying the carcasses. But we canR17;t help asking ourselves what we would have done if this virus had occurred in humans. We canR17;t dig holes and bury all the people in the world.307 [375] (c) BirdFluBook.com | Home [376] | Website by Lantern Media [377] Bird Flu - What Happens to a Pandemic Deferred? BirdFluBook.com [378] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [379] What Happens to a Pandemic Deferred? Culling in Indonesia The killing of all the chickens in Hong Kong in 1997 stopped H5N1, but not for long. The same underlying conditions that originally led to its emergence were still in place; it was just a matter of time. Experts think human influenza started about 4,500 years ago with the domestication of waterfowl like ducks, the original source of all influenza viruses.308 [380] According to the University of Hong KongR17;s Kennedy Shortridge, this R20;brought influenza viruses into the R16;farmyard,R17; leading to the emergence of epidemics and pandemics.R21;309 [381] Before 2500 B.C.E., likely nobody ever got the flu. Duck farming dramatically spread and intensified over the last 500 years, beginning during the Ching Dynasty in China in 1644 A.D.310 [382] Farmers moved ducks from the rivers and tributaries onto flooded rice fields to be used as an adjunct to rice farming. This led to a permanent year-round gene pool of avian influenza viruses in East Asia in close proximity to humans.311 [383] The domestic duck of southern China is now considered the principal host of all influenza viruses with pandemic potential.312 [384] This is probably why the last two pandemics started in China.313 [385] According to the UN Food and Agriculture Organization (FAO), China is the largest producer of chicken, duck, and goose meat for human consumption.314 [386] It accounts for 70% of the worldR17;s tonnage of duck meat and more than 90% of global goose meat.315 [387] China has more than two dozen species of waterfowl.316 [388] As Osterholm has said, R20;China represents the most incredible reassortment laboratory for influenza viruses that anyone could ever imagine.R21;317 [389] Extensive sampling of Asian waterfowl in the years following the Hong Kong outbreak seems to have tracked H5N1 to a farmed goose outbreak in 1996, the year the number of waterfowl raised in China exceeded 2 billion birds.318 [390] The virus seemed to have been playing a game of Duck, Duck, GooseR30;then Chicken. In 2001, the virus arose again from the primordial reservoir of waterfowl to make a comeback among chickens in Hong Kong.319 [391] Once again, all of the chickens were destroyedR12;this time before anyone fell ill.320 [392] Sporadic outbreaks continued through 2002, but people didnR17;t start dying again in Hong Kong until 2003.321 [393] By the end of that year, the virus would escape China and start its rampage across the continent. As revelers got ready to ring in 2004, the FAO and other international organizations began to hear rumors of widespread outbreaks of a virulent disease obliterating chicken flocks across Southeast Asia.322 [394] Reports were coming from so many directions at the same time that authorities didnR17;t know which to believe. Within a month, though, they were all confirmed. H5N1 had burst forth from China, erupting nearly simultaneously across eight countries. It quickly became the greatest outbreak of avian influenza in history.323 [395] Given the pattern and timing of outbreaks, trade in live birds was blamed for the spread throughout Southeast Asia.324 [396] For example, chickens made nearly a thousand-mile jump from the Ganzu province in China to Tibet via truck.325 [397] The Vietnamese Prime Minister quickly imposed a ban on all transport of chickens,326 [398] but the widespread smuggling of birds is thought to have continued the viral spread throughout the region.327 [399] It would be another year before the virus would learn how to hitch rides on migratory waterfowl to wing its way westward,328 [400] although a Lancet editorial notes that the poultry trade may also have played a role in the spread of H5N1 to the Middle East, Europe, and Africa.329 [401] Even in the United States, a shipment of chicken parts marked R20;jellyfishR21; was allegedly smuggled in from Thailand and distributed to ten states before it was confiscated.330 [402] At a single port in California, customs agents intercepted illegal shipments of nearly 75 tons of poultry smuggled in from Asia and about 100,000 eggs within a three-month period in 2005.331 [403] One biologist remarked that the reason why the focus has remained on wild birds is that R20;[c]orporations pay more taxes than migratory birds doR30;.R21;332 [404] Within a few months, more than 100 million chickens across Asia were killed by the disease or culled.333 [405] They were buried alive by the millions in Thailand and burned alive in China.334 [406] Birds were stomped to death in Taiwan and beaten to death in Vietnam.335 [407] The French media reported: R20;Soldiers stripped to the waist pound terrified ducks with bloody sticks; farmers dressed in grubby clothes grab chickens squawking from their cages to wring their necks, and twitching bags stuffed with live birds are tossed into a ditch and covered in dirt.R21;336 [408] Lest Westerners judge, the U.S. egg industry has thrown live hens with waning egg productivity into wood chippers337 [409] and continues to drop living male baby chicks of egg-laying breeds into high-speed grinders.338 [410] Humane considerations aside, the World Health Organization is concerned that the methods of culling and disposal could increase the risk of human exposure. R20;If [the killing of birds] is done in such a way that exposes more people [to the virus],R21; said one WHO spokesperson, R20;then thisR30;could be increasing the risk of developing a strain that you would not want to see.R21;339 [411] Despite the culling, the virus came back strong in the fall of 2004, spreading its wings throughout Southeast Asia, and hasnR17;t left since.340 [412] As 2004 came to an end, former U.S. Secretary of Health and Human Services Tommy G. Thompson told reporters in his farewell news conference that H5N1 was his greatest fear, eclipsing bioterrorism. Bird flu, he said, was a R20;really huge bomb.R21;341 [413] (c) BirdFluBook.com | Home [414] | Website by Lantern Media [415] Bird Flu - Year of the Rooster BirdFluBook.com [416] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [417] Year of the Rooster Sick tiger 2005, the Chinese zodiacR17;s Year of the Rooster, saw a resurgence of human deaths. By June, more than 100 laboratory-confirmed cases were reported to the WHO, with more than 50 deaths.342 [418] The year also saw the continuation of an alarming trend in the growth of H5N1R17;s learning curve. The WHOR17;s Klaus Stohr explained in an editorial in the New England Journal of Medicine: R20;Recent laboratory and epidemiologic studies have yielded disturbing evidence that the H5N1 virus has become progressively more pathogenic in poultry, has increased environmental resistance, and is expanding its mammalian host range.R21;343 [419] By 2003, H5N1 had undergone more than a dozen reassortments with other influenza viruses since its re-emergence among domestic poultry in 2001, trading genes like baseball cards and forming a powerhouse H5N1 mutant known to scientists as type Z. The virus was shuffling between more than a dozen decks, picking all the best cards. The adaptations that allowed Z to survive in the ambient environment augmented the virusR17;s ability to infect, spread, and mutate even further. Within a year the mutant Z+ was born.344 [420] Z+ led to the explosion of cases across Asia in 2004. H5N1 had slowly but surely mastered the ability to spread among chickens with supreme efficiency, flooding across poultry-raising nations. It had also gotten better at killing. University of Wisconsin virologists were the first to show that the virusR17;s lethality was not limited to birds. Influenza viruses donR17;t typically kill mammals like mice, but in the lab. Z+ killed 100% of the test population, practically dissolving their lungs.345 [421] R20;This is the most pathogenic virus that we know of,R21; declared the lead investigator. R20;One infectious particleR12;one single infectious virionR12;kills mice. Amazing virus.R21;346 [422] Crystallography studies showed that on a molecular level the virus had begun structurally to look more like the virus of 1918.347 [423] H5N1 began taking more species under its wing. Reports came from China that pigs were infected,348 [424] raising a concern that these animals could act as additional gene R20;swap meets.R21; Since pigs can be infected with both human and avian flu, they are thought to act as R20;mixing vesselsR21; for influenza viruses.349 [425] Pet cats began to die.350 [426] This was the first time on record that cats had ever come down with the flu. Cats had always been considered resistant to getting the disease.351 [427] R20;If avian influenza has one predictable property, it is that it is not predictable,R21; lamented an Ohio State University biologist. R20;It has made a fool of us more than once.R21;352 [428] The WHO wrote, R20;The reported infection of domestic cats with H5N1 is an unusual event in what is an historically unprecedented situation.R21;353 [429] Tigers and leopards in zoos who were fed chickens from the local slaughterhouse fell ill and died.354 [430] In ThailandR17;s largest tiger zoo, more than a hundred big cats were killed. There was evidence that the virus was able to spread from tiger to tiger.355 [431] Experimental studies seem to have confirmed the suspicion.356 [432] WebsterR17;s lab discovered that ferrets could also be infected with the virus, leading to rapid paralysis and death. R20;Everything it does is rather frightening,R21; said Webster.357 [433] R20;The outbreaks indicate that the virus has become highly pathogenic to more and more species,R21; reported Shigeru Omi, WHO regional director for the Western Pacific region. R20;The virus remains unstable, unpredictable and very versatile. Anything could happen. Judging from the way the virus has behaved it may have new and unpleasant surprises in store for us.R21;358 [434] The feline outbreaks had researchers very concerned. The virus was getting better adapted to killing mammals. R20;Every species leap [by H5N1] represents a new virus mutation, increasing the chance that one will become highly infectious to humans,R21; explained one WHO epidemiologist.359 [435] Not only was the virus getting a better feel for mammalian biology, it was beginning to learn how to spread mammal to mammal. Because cats, unlike pigs, are resistant to human influenza, they would presumably not be able to act as mixing vessels in which viral gene shuffling could potentially form bird-human hybrid viruses like those that triggered the pandemics of R17;57 and R17;68. But what the cat could drag in is a facilitation of the stepwise adaptation of the avian virus towards direct human infection and transmission, as presumably occurred in the pandemic of 1918. These home and zoo outbreaks also suggest viral infection in the meat. (c) BirdFluBook.com | Home [436] | Website by Lantern Media [437] Bird Flu - R20;Where chicken soup used to cure the flu, now it gives you the flu.R21; BirdFluBook.com [438] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [439] R20;Where chicken soup used to cure the flu, now it gives you the flu.R21; R12;Jay Leno360 [440] Raw blood soup (tiN71;t canh) To avoid contracting bird flu, an influenza expert at the UK Health Protection Agency warned, R20;Avoid being in touching distance [of birds who could be affected]. DonR17;t kiss chickens.R21;361 [441] Kissing aside, what is the risk of putting our lips on them other ways? Investigators suspect that at least five people living near Hanoi contracted H5N1 after dining on congealed duck blood pudding, a traditional Vietnamese dish called tiet canh vit prepared from a duckR17;s blood, stomach, and intestines.362 [442] This led the FAO to advise, R20;People should not eat raw blood.R21;363 [443] But what about the muscle tissue we know as meat? In 2001, the virus was found and confirmed in frozen Pekin duck meat exported from mainland China. The investigators concluded, R20;The isolation of an H5N1 influenza virus from duck meat and the presence of infectious virus in muscle tissue of experimentally infected ducks raises concern that meat produced by this species may serve as a vehicle for the transmission of H5N1 virus to humans.R21;364 [444] Inexplicably, after meeting with the Chinese President in April 2006, President George W. Bush agreed to allow the resumption of poultry imports from China starting in May. Although the meat would be cooked before export, which should kill the virus, members of the U.S. House and Senate agriculture committees expressed concern about quality control in Chinese processing plants.365 [445] Some critics suspect that this concession was made in return for ChinaR17;s promise to drop the mad cow disease-related ban on U.S. beef imports.366 [446] The finding of H5N1-contaminated poultry meat triggered a more extensive survey. Investigators randomly sampled duck meat from China and found that 13 of 14 imported lots all contained up to a thousand infectious doses of virus within the meat. The researchers concluded that R20;the isolation of H5N1 viruses from duck meat reveals a previously unrecognized source for human exposure to potential highly pathogenic viruses.R21;367 [447] Top flu researchers at the U.S. Department of Agriculture (USDA) looked into chicken. Chickens who inhaled H5N1 became infected even more systemically than did ducks.368 [448] The virus spread through the internal organs, into the muscle tissue, and even out into the skin. Virus was found in both white and dark meat.369 [449] There is a precedent for bird-borne virus-infected meat.370 [450] Unlike bacteria, viruses can remain infective for prolonged periods even in processed foods. Some methods of preservation, like refrigeration, freezing, or salting, may even extend the persistence of viruses in food.371 [451] On the other hand, since viruses cannot replicate without living tissue, improper storage of food is less problematic.372 [452] When someone gets hepatitis from eating strawberries, it didnR17;t come from the strawberriesR12;they donR17;t have livers. The virus came from human or nonhuman fecal material, the cause of nearly all foodborne illness. For the same reason that people donR17;t get Dutch Elm Disease or ever seem to come down with a really bad case of aphids, food products of animal origin are the source of most cases of food poisoning,373 [453] with chicken the most common culprit.374 [454] Poultry and eggs seem to cause more food poisoning cases than red meat, seafood, and dairy products combined.375 [455] Due to viral contamination of meat in general, those who handle fresh meat for a living can come down with unpleasant conditions with names like contagious pustular dermatitis. Fresh meat is so laden with viruses that there is a well-defined medical condition colloquially known as R20;butcherR17;s warts,R21; affecting the hands of those who handle fresh poultry,376 [456] fish,377 [457] and other meat.378 [458] Even wives of butchers seem to be at higher risk of cervical cancer,379 [459] a cancer definitively associated with wart virus exposure.380 [460] Concerns about viral infection have led to recommendations that pregnant women and people with AIDS not work the slaughter lines.381 [461] Proper cooking of the meat, though, utterly kills all known viruses. Isolated viruses like influenza can be killed by exposure to 158degreeF for less than a minute in a laboratory setting.382 [462] In the kitchen, however, itR17;s a little more complicated. While some authorities feel that one can just cook until the meat is no longer pink and the juices run clear, USDA bird flu guidelines insist on the use of a meat thermometer. USDA recommends cooking whole birds to 180°F as measured in the thigh, while an individual breast need only reach an internal 170°F. Drumsticks, thighs, and wings cooked separately should reach 180°F inside, but ground turkey and chicken need only be cooked to 165°F, though the minimum oven temperature to use when cooking poultry should never drop below 325°F. According to the USDA bird flu Q & A press release, details are available online.383 [463] Because proper cooking methods kill the virus384 [464] no matter how deadly it is, the standard government and industry line remains: R20;There is no risk of getting avian influenza from properly cooked poultry and eggs.R21;385 [465] But that can be said about nearly all foodborne illnesses. The CDC estimates that 76 million Americans come down with food poisoning every year. Annually, an estimated 5,000 Americans die as a result of foodborne illness.386 [466] And every single one of those millions of infections, every single one of those thousands of deaths, was caused by a virus or bacteria that should have been utterly destroyed by R20;properR21; cooking. So why are tens of millions of Americans still falling ill? (c) BirdFluBook.com | Home [467] | Website by Lantern Media [468] Bird Flu - Cooking the Crap Out of It BirdFluBook.com [469] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [470] Cooking the Crap Out of It Tyson slaughter plant Cross-contaminationR12;the infection of kitchen implements, surfaces, or food during preparation before cookingR12;is considered the predominant cause of food poisoning.387 [471] R20;It does not require much imagination,R21; reads a public health textbook, R20;to appreciate the ease with which a few hundred bacteria can be transferred from, say, a fresh broiler [chicken] covered in a million bacteria to a nearby bit of salad or piece of bread.R21;388 [472] Knowing that poultry is the most common cause of food poisoning in the home, microbiologists had 50 people take chicken straight from a supermarket and prepare a meal with it as they normally would in their own kitchen. The researchers then took samples from such kitchen staples as sponges, dishcloths, and hand towels, and tested them for the presence of disease-causing bacteria like Campylobacter and Salmonella. They found multiple contaminated samples. R20;AntibacterialR21; dishwashing liquid did not seem to offer any protection. They conclude, R20;Pathogenic bacteria can be recovered relatively frequently from the kitchen environment.R21;389 [473] Some animal parts are so contaminated that the CDC recommends that during preparation the household meat handler find caretakers to supervise his or her children so as not to infect them.390 [474] The risk of cross-contamination with the bird flu virus may be especially high because it exists not just in the meat, but on it. The World Health Organization describes where most bird flu infections have originated: R20;[D]irect touching of poultry or poultry feces contaminated surfaces, eating uncooked poultry products (e.g., blood) or preparing poultry have been considered the probable routes of exposure leading to infection in most older children and adults.R21;391 [475] Unfortunately, the R20;poultry feces contaminated surfacesR21; may be our countertops. R20;Influenza virus is excreted in the feces,R21; a CDC epidemiologist explains. R20;Chickens and ducks have fecal matter all over them.R21;392 [476] Medical researchers at the University of Minnesota recently took more than a thousand food samples from multiple retail markets and found evidence of fecal contamination in 69% of the pork and beef and 92% of the poultry samples, as evidenced by contamination with the intestinal bug E. coli.393 [477] This confirms USDA baseline data stating, astonishingly, that R20;greater than 99% of broiler carcasses had detectable E. coli.R21;394 [478] R20;If chicken were tap water,R21; journalist Nicols Fox writes in her widely acclaimed book Spoiled, R20;the supply would be cut off.R21;395 [479] Most Americans donR17;t realize that our poultry supply is contaminated with fecal matter. Delmer Jones, president of the U.S. Meat Inspection Union, describes the current USDA labels as misleading to the public. He suggests, R20;The label should declare that the product has been contaminated with fecal material.R21;396 [480] Eric Schlosser in Fast Food Nation proposes a more straight-forward approach: R20;There is shit in the meat.R21;397 [481] How did it get there? After chickens are shackled, stunned, have their necks cut, and bleed to death, they are scalded, defeathered, and have their heads and feet removed. The next step is evisceration. Birds are typically gutted by a machine that uses a metal hook to pull out their guts.398 [482] The intestines are often ripped in the process, spilling the contaminated contents over the carcass. If even a single bird is infected, the machinery is then contaminated and can pass infection down the line. In one study, when one chicken was inoculated with a tracer bacteria, the next 42 birds subsequently processed were found to be cross-infected. Sporadic contamination occurred up to the 150th bird.399 [483] The World Health Organization concludes that large, centralized, and mechanized slaughter plants may R20;create hazards for the human food chain.R21;400 [484] Millions of chickens miss the killing blade and are drowned in the scalding tanks every year,401 [485] in part because the USDA does not include poultry under the protections of the federal Humane Methods of Slaughter Act.402 [486] The birds, still conscious, may defecate in the tanks and inhale water polluted by fecal leakage into their lungs,403 [487] which can lead to further contamination of the carcass down the line.404 [488] So-called R20;controlled atmosphere killing,R21; which uses inert gases to essentially put the birds to sleep, is a more hygienic method of slaughter.405 [489] According to former USDA microbiologist Gerald Kuester, R20;there are about 50 points during processing where cross-contamination can occur. At the end of the line, the birds are no cleaner than if they had been dipped in a toilet.R21;406 [490] The toilet, in this case, is the chill water bath at the end of the line in which the birdsR17; remains soak for an hour to increase profitability by adding water weight to the carcass. At this point, the bath water is more of a chilled fecal soup. This collective soak has been shown to increase contamination levels by almost a quarter. R20;That extra 24% of contamination the chill water adds,R21; writes Nicols Fox, R20;can be credited to pure greed.R21;407 [491] As Fox points out in Spoiled, the microbiologistR17;s assertion that the R20;final product is no different than if you stuck it in the toilet and ate itR21; is not gross hyperbole. Gross, perhaps, but not hyperbole. In fact, the toilet might actually be safer than your sink. Researchers at the University of Arizona found more fecal bacteria in the kitchenR12;on sponges, dish towels, the sink drain, countertopsR12;than they found swabbing the rim of the toilet.408 [492] Comparing surfaces in bathrooms and kitchens in the same household, the investigators note that R20;consistently, kitchens come up dirtier.R21;409 [493] The excess fecal contamination is presumed to come from raw animal products brought into the home. As Fox points out. R20;The bathroom is cleaner because people are not washing their chickens in the toilet.R21;410 [494] (c) BirdFluBook.com | Home [495] | Website by Lantern Media [496] Bird Flu - Handle with Care BirdFluBook.com [497] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [498] Handle with Care Consumer Reports chicken contamination investigation [499] Animal manure is the source of more than 100 pathogens, including bacteria, parasites, and viruses that could be transmitted from animals to humans, such as influenza.411 [500] According to the WHOR17;s International Food Safety Authorities Network, when it comes to bird flu viruses like H5N1, R20;handling of frozen or thawed raw poultry meat before cooking can be hazardous if good hygiene practices are not observed.R21;412 [501] According to the USDA, this includes washing hands, cutting boards, knives, utensils, and all countertops and surfaces with hot, soapy water after cutting raw meats. All meat and their R20;juicesR21; need to be quarantined away from all other foods. Further, cutting boards need to be sanitized with a chlorine bleach solution (1 teaspoon bleach in 1 quart of water), and food thermometers should be used without exception.413 [502] One state epidemiologist describes what she does to avoid foodborne illness risks in general: R20;I assume that poultry is contaminated, and that any package of hamburger I buy is grossly contaminated too. When IR17;m preparing a turkey or hamburger, I have everything out and ready, the pan on the counter, right where my meat is, so that I donR17;t have to go in the cupboard to get it. Then IR17;ve got the soap handy, of course. After I handle the meat, I use my wrists to turn on the faucet so IR17;m not touching it with my dirty hands. I wash my hands thoroughly for at least thirty seconds.R21;414 [503] This is why the official U.S. poultry industryR17;s slogan should bird flu ever hit the country, R20;Avian Influenza: ItR17;s not in your food,R21;415 [504] may be so misleading. ThatR17;s like saying Salmonella is not in your food. Or Campylobacter is not in your food. Tell that to the millions of Americans who fall ill every year from these poultry pathogens.416 [505] Would we go to the store and pick up a package of meat that might be contaminated with HIV or hepatitis, even if there was a certainty that the virus was killed by cooking? We presumably wouldnR17;t want to risk bringing any potentially deadly viruses into our home. Poultry industry spokespeople dismiss consumer concern in affected countries as R20;totally irrational,R21;417 [506] but the public seems instead to be taking a precautionary approach which may be prudent given the prevailing uncertainties.418 [507] Leading flu expert Albert Osterhaus, director of the Netherlands National Influenza Centre, concludes, R20;Available evidence suggests that the gastrointestinal tract in humans is a portal of entry for H5N1.R21;419 [508] A WHO spokesperson adds the critical caveat: R20;The chicken is safe to eat if it is well cooked, provided that the people preparing the chicken have not contaminated themselves from somewhere.R21;420 [509] Thai government officials reportedly confirmed that a 48-year-old man died of bird flu after cooking and eating a neighborR17;s infected chickens.421 [510] Maybe he didnR17;t properly Clorox his cutting board or he accidentally used his hand to turn on the kitchen faucet. Maybe he didnR17;t sterilize his meat thermometer every time he checked to see if the fecal viruses had been killed. R20;To me,R21; writes Nicols Fox, R20;it is really asking the consumer to operate a kind of biohazard lab.R21;422 [511] Consider the CDCR17;s recommended disposal methods for carcasses known to be infected with bird flu: * Disposable gloves made of lightweight nitrile or vinyl or heavy duty rubber work gloves that can be disinfected should be wornR30;. Gloves should be changed if torn or otherwise damaged. Remove gloves promptly after use, before touching non-contaminated items and environmental surfaces. * Protective clothing, preferably disposable outer garments or coveralls, an impermeable apron or surgical gowns with long cuffed sleeves, plus an impermeable apron should be worn. * Disposable protective shoe covers or rubber or polyurethane boots that can be cleaned and disinfected should be worn. * Safety goggles should be worn to protect the mucous membranes of eyes. * Disposable particulate respirators (e.g., N-95, N-99, or N-100) are the minimum level of respiratory protection that should be wornR30;. Workers must be fit-tested to the respirator model that they will wear and also know how to check the face-piece to face seal. Workers who cannot wear a disposable particulate respirator because of facial hair or other fit limitations should wear a loose-fitting (i.e., helmeted or hooded) powered air purifying respirator equipped with high-efficiency filters.423 [512] This should give pause to those of us who might unknowingly dispose of infected carcasses through consumption. Bird flu viruses like H5N1 can survive in feces as long as 35 days at low temperatures.424 [513] But canR17;t we just wash it off? Though the virus may still actually be in the meat itself, with proper cooking those viruses should die. Poultry companies are actually revising labeling to steer consumers away from the age-old practice of washing a fresh bird inside and out.425 [514] In fact, the new federal dietary guidelines specifically recommend that R20;meat and poultry should not be washed or rinsed.R21; The USDA is concerned that this practice could cause viral or bacterial splatter from R20;raw meat and poultry juices.R21; Animals, of course, are not fruit; they donR17;t really have R20;juice,R21; per se. R20;Chicken juiceR21; is the fecal broth absorbed in the chill bath. The Tufts University Health and Nutrition Letter explains: R20;Your own hands, where they grasped the meat while washing it, could become just as bacteria-laden as the surface of the foodR30;. The best bet is to leave meat or poultry untouched until you start cooking it.R21;426 [515] What are we supposed to do, levitate it into the oven? New research suggests we could infect ourselves before even leaving the grocery store. Researchers recently published a study in the Journal of Food Protection in which they swabbed the plastic-wrapped surface of prepackaged raw meat in grocery stores for fecal contamination. Even though most of the packages looked clean on the outside, the researchers found Salmonella, Campylobacter, and multidrug-resistant E. coli on the outer surface of the packages, suggesting that just picking up a package of meat in the store could put one at risk. Poultry beat the competition for the most contamination. A single swab picked up more than 10,000 live E. coli bacteria. The researchers conclude, R20;The external packaging of raw meats is a vehicle for potential cross-contamination by Campylobacter, Salmonella, and E. coli in retail premises and consumersR17; homes.R21;427 [516] Realizing this level of contamination, bird flu experts at a CDC symposium reminded consumers not to touch our mucous membranesR12;rub our eyes or nosesR12;while handling any raw poultry products.428 [517] Vegetarian? Risk applies to non-meat-eaters as well: Any fecal-fluid drippings of bird droppings trailing down the checkout counter conveyer belt could easily contaminate fresh produce. A cooked fly in oneR17;s soup poses no danger. Fecal matter, once properly shaked and baked, may be perfectly safe, but we may still not want to feed it to our family. R20;After all,R21; as Consumer Reports puts it, R20;sterilized poop is still poop.R21;429 [518] What would we do if we found out that there was a small chance that in the back of the grocery store, some malicious prankster had smeared our dinner with bird droppings? Would we still buy it? What if the chance of contamination was greater than 90%? Time magazine put it this way: R20;The good news about chicken is that thanks to modern processing techniques, it costs only about a third of what it did two decades ago. The bad news is that an uncooked chicken has become one of the most dangerous items in the American home.R21;430 [519] There are a number of toxins that can make one ill that are denatured (destroyed) by cooking, such as botulinum toxin, the cause of botulism. Even if such a toxin is rendered utterly and completely harmless by cooking, would we still consider bringing contaminated products into our homes, putting them onto the kitchen counter, and feeding them to our kids, knowing that one accident on our part, one little spill, one little drip, could potentially land our loved ones in the hospital? Some suggest keeping birds out of the kitchen altogether. During an interview recorded by the Government Accountability Project, a USDA meat inspector stated: I will not buy inspected productR12;only what I raise. I do not eat out, and I donR17;t allow my children to eat at school. We didnR17;t use to have to put warning labels on product for R20;safe handlingR21; but we do now. This is just a politically correct way of saying R20;cook good, this product may contain fecal matter and other poor sanitary handling bacterias.R21; I was told by a supervisor some time back that if you cook a piece of [feces] to 170 degrees you can eat it and it wonR17;t hurt you. But I donR17;t really think the consumer is aware of the [feces] they are being fed.431 [520] (c) BirdFluBook.com | Home [521] | Website by Lantern Media [522] Bird Flu - Soft-Boiled Truth BirdFluBook.com [523] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [524] Soft-Boiled Truth Runny yolks may present a health hazard What about eggs? R20;Be careful with eggs,R21; the World Health Organization warns.432 [525] R20;Eggs from infected poultry could also be contaminated with the [H5N1] virus and therefore care should be taken in handling shell eggs or raw egg products.R21;433 [526] This includes first washing eggs with soapy water and then afterwards washing our hands and all surfaces and utensils thoroughly with soap and water.434 [527] Given that pigs fed eggs from an infected flock fell ill, researchers maintain that the R20;survival time of the virusesR30;on surfaces such as eggs is sufficient to allow wide dissemination.R21;435 [528] According to the European Centre for Disease Prevention and Control, the biggest risk from eggs is that the shells may harbor traces of excrement containing the virus.436 [529] The comic strip One Big Happy by Rick Detorie once explained the layers of infection. A father and daughter are in the grocery store. R20;ThatR17;s a cowR17;s tongue?!R21; the girl exclaims, face contorted in disgust. R20;EEEEwwR30;I would never eat anything that was in a cowR17;s mouth!R21; R20;Me neither,R21; replies the father, not looking up from his shopping list. R20;LetR17;s see, where are the eggs?R21; The daughter stops, eyes wide in realization: R20;Wait a minute!R21; Eggs do, after all, come out of a chickenR17;s rear (vagina and rectum combine into the cloaca). Like Salmonella, bird flu viruses can infect the chickensR17; ovaries, so the virus can come prepackaged within the egg as well.437 [530] During the 1983 Pennsylvania outbreak, the virus was found festering within both the egg white and the yolk, making proper cooking essential.438 [531] To reduce the risk of contracting bird flu from eggs, the Mayo Clinic warns about mayo: R20;Avoid eating raw or undercooked eggs or any products containing them, including mayonnaise, hollandaise sauce and homemade ice cream.R21;439 [532] Other potential sources of raw or undercooked eggs include mousse, Caesar salad, homemade eggnog, lemon meringue pie, tiramisu, raw cookie dough, and eggs that are soft boiled, lightly poached, or cooked sunny side up or R20;over easyR21; with a runny yolk. The latest CDC440 [533] and WHO441 [534] recommendations are adamant on this pointR12;whether itR17;s to avoid bird flu or Salmonella, egg yolks should not be runny or liquid. Researchers concluded in the Journal of the American Medical Association that R20;no duration of frying R16;sunnysideR17; (not turned) eggs was sufficient to kill all the Salmonella.R21;442 [535] But havenR17;t people been cooking eggs that way for a hundred years? Diseases like bird flu and Salmonella were practically unknown a few decades ago. Our grandparents could drink eggnog with wild abandon while their grandkids could eat raw cookie dough without fear of joining the more than a thousand Americans who die every year from Salmonella poisoning. There was a time when medium-rare hamburgers, raw milk, and steak tartare were less dangerous, a time when Rocky Balboa could more safely drink his raw-egg smoothies. Blaming customers for mishandling or improper cooking is only possible when all this is forgotten. USDA microbiologist Nelson Cox says, R20;Raw meats are not idiot-proof. They can be mishandled and when they are, itR17;s like handling a hand grenade. If you pull the pin, somebodyR17;s going to get hurt.R21; While some may question the wisdom of selling hand grenades in the supermarket, Cox disagrees: R20;I think the consumer has the most responsibility but refuses to accept it.R21;443 [536] R20;There has been a subtle turning of this on to the consumer,R21; says Steve Bjerklie, former editor of Meat and Poultry magazine, R20;and itR17;s morally reprehensible.R21;444 [537] Patricia Griffin, director of Epidemiological Research at the Centers for Disease Control responded famously to this kind of blame-the-victim attitude. R20;Is it reasonable,R21; she asked, R16;R20;that if a consumer undercooks a hamburgerR30;their three-year-old dies?R21;445 [538] Pre-processed foods, however, are undeniably industryR17;s responsibility. Eggs used in processed food products are pasteurized first to ensure safety. Because the use of eggs is so widespread in the processed food industry (about one-third of the eggs Americans consume are eaten in products),446 [539] USDA researchers recently studied standard industry pasteurization protocols to make certain that no bird flu virus was left alive. Although they found that pasteurization did kill the virus in liquid eggs (used in products like Egg Beaters(R)), the standard method used to pasteurize dried egg productsR12;which are ubiquitously found in the processed food and baking industriesR12;was not effective in eliminating the deadliest bird flu viruses. The USDA researchers showed that while the industry standard R20;low temperature pasteurization protocolR21;R12;a week at 130°FR12;killed the low-grade bird flu viruses naturally adapted to wintering in ice-cold Canadian lakes, the high-grade bird flu viruses like H5N1 adapted to land-based domestic poultry survived more than two weeks at that temperature. The length of time required to kill the virus, about 15 days, was considered inconsistent with R20;commercial application.R21;447 [540] (c) BirdFluBook.com | Home [541] | Website by Lantern Media [542] Bird Flu - Tastes Like Chicken BirdFluBook.com [543] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [544] Tastes Like Chicken Virginia outbreak of bird flu in 2002 Government reactions to egg and poultry food safety recommendations in light of bird flu have been mixed. In Indonesia and Pakistan,448 [545] health ministers called upon people to stop consuming chicken and eggs for the time being,449 [546] whereas the Prime Minister of Thailand promised 3 million baht ($76,000) to relatives of anyone dying from cooked eggs or chicken.450 [547] The international airport in Rome is promising the R20;destruction by incineration of any poultry-based food found in the luggage of passengers traveling from risk areas.R21;451 [548] A European Food Safety Authority advisory panel advised Europeans to cook all eggs and chicken carefully in light of the disease spreading from Asia.452 [549] They also cautioned that down and feathers originating from affected areas R20;may be infective due to contamination with infective faeces or other body fluids,R21; noting that processing methods for these materials R20;vary widely as regards virus reduction.R21;453 [550] U.S. officials appear less concerned. During a 2002 outbreak of low-grade avian influenza across Virginia, West Virginia, and North Carolina, most of the millions of infected and potentially infected carcasses were disposed of in landfills at a cost of up to $140 per ton of carcasses. Incineration is even more expensive, costing producers $500 per carcass ton.454 [551] So USDAR17;s chief flu researcher David Swayne, along with the now-Assistant State Veterinarian of New York, recommended producers instead try to recoup the costs of culling by selling sick birds for human consumption. They argued that since only high-grade viruses have been found in skeletal muscle meat, it was okay for producers to market birds infected with low-grade viruses for food as a cheap R20;method of elimination.R21;455 [552] Remarkably, Swayne has since disclosed that a scientist in his own lab demonstrated in the early 1990s that even low-grade bird flu viruses infect the birdsR17; abdominal air sacs that extend up into the breastbone and the humerus on the wing. R20;[S]o there would be obviously a potential for air sac contamination of the associated meat products if they contained bone,R21; Swayne admitted.456 [553] Swayne suggests that even birds infected with high-grade bird flu viruses could be used as meat as long as they were sent for further processing and turned into precooked products.457 [554] The Food and Agriculture Organization of the United Nations disagrees. R20;Poultry from infected flocks should be disposed of by environmentally sound methods and should not be processed for animal and human food consumption.R21;458 [555] The FAO frowns on disposing of infected carcasses by putting them on our dinner plates. Even suspect birds not yet showing signs of infection, according to the FAO, should be destroyed and disposed of and should R20;not be allowed to enter the human food chain or be fed directly or indirectly to other animals including zoo animals.R21;459 [556] During the 2002 U.S. outbreak even the rendering industryR12;which turns slaughterhouse waste, roadkill, and euthanized pets into farm animal feed and pet food460 [557] R12;was reluctant to accept birds from an avian influenza outbreak because of the stigma attached to the disease.461 [558] Too tainted for pets, but not for kids? (c) BirdFluBook.com | Home [559] | Website by Lantern Media [560] Bird Flu - Higher Human Learning BirdFluBook.com [561] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [562] Higher Human Learning H5N1 may attack the brain The Z+ strain of H5N1 has not only been getting better at killing other mammals like mice, pigs, and cats, it has learned to burrow deep into human lungs. The scientist who discovered the SARS virus explains how H5N1 has been mutating to better effect our death: R20;Unlike the normal human flu, where the virus is predominantly in the upper respiratory tract so you get a runny nose, sore throat, the H5N1 virus seems to go directly deep into the lungs so it goes down into the lung tissue and causes severe pneumonia.R21;462 [563] The director of Oxford UniversityR17;s Clinical Research Unit in Ho Chi Minh City describes how shocked he was by what he was seeing. R20;IR17;ve never experienced anything like it in terms of its destructive power,R21; he said. R20;It is staggering in terms of how much lung tissue is destroyed.R21;463 [564] H5N1 and the virus of 1918 both shared a proclivity for the lungs, but H5N1 doesnR17;t always stop there. It may dig deeper, invading the bloodstream to ravage other internal organs. What starts as a respiratory infection may become a whole-body infection. Researchers were surprised to find that the 1918 virus, with all its fury, had not mutated to destroy other organs. This is thought to be why H5N1 may be more than ten times more lethal than the virus that sparked the greatest medical tragedy in human history.464 [565] As human contagious diseases go, only Ebola and untreated HIV infection are deadlier.465 [566] But H5N1 could go airborne. In a tone one rarely finds in scholarly medical journals, Lancet, perhaps the most prestigious medical journal in the world, editorialized, R20;In view of the mortality of human influenza associated with this strain, the prospect of a worldwide pandemic is massively frightening.R21;466 [567] One of the organs H5N1 can damage, the medical world swiftly realized, is the human brain. The first case report in the New England Journal of Medicine started with the line: R20;In southern Vietnam, a four-year-old boy presented with severe diarrhea, followed by seizures, coma, and death.R21; His nine-year-old sister had died similarly two weeks earlier. She was fine one day, and dead five days later. Her brother lasted a week. The bird flu virus seemed to attack their central nervous systems, plunging them into rapidly progressing fatal comas. The Oxford investigators concluded, R20;These reports suggest that avian influenza A (H5N1) virus is progressively adapting to mammals and becoming more neurologically virulent.R21;467 [568] R20;This virus is particularly nasty,R21; says Nancy Cox, the chief influenza scientist at the CDC. R20;WeR17;ve never seen any influenza virus quite like it before.R21;468 [569] Researchers werenR17;t sure how the virus got to the brain. They assumed it traveled there through the bloodstream where live virus has been found,469 [570] but experimental studies showed a possible alternate route. Once inhaled, the virus may creep up the olfactory nerves used for our sense of smell, leading to direct brain invasion though the nose.470 [571] H5N1 is like no flu virus anyone has ever seen. St. JudeR17;s Robert Webster describes the virus as a R20;wily adversary.R21; R20;Just when you start to think that youR17;ve understood what it can do then it pulls another one out of the bag,R21; Webster said. R20;ItR17;s one of the most crafty of all infectious disease agents. ItR17;s got such a repertoire of tricks.R21;471 [572] H5N1 is still having trouble, to date, learning how to pull off its greatest trick of allR12;efficient human-to-human spread. (c) BirdFluBook.com | Home [573] | Website by Lantern Media [574] Bird Flu - Mano-a-Mano BirdFluBook.com [575] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [576] Mano-a-Mano First documented lethal human to human transmission First, her chickens died. Then, her niece died, coughing blood as she expired in her motherR17;s arms.472 [577] In 2005, the New England Journal of Medicine reported the first documented case of deadly human-to-human transmission. Until that point, nearly all of the human deaths had R20;involved people who lived or worked with poultry, poultry meat or eggs in Southeast Asia.R21;473 [578] While the 11-year-old niece was exposed to sick chickens while living in a village with her aunt, her mother arrived from the Bangkok suburbs to care for her and had no known exposure to chickens, sick or otherwise. The day after the funeral, the mother started to feel sick too, and after severe illness, died. The aunt also fell sick, but recovered.474 [579] Both she and her sister tested positive for the same virus that had killed the child.475 [580] The report sent shivers down the spine of the scientific and medical community.476 [581] In the week following the report, the European science publication New Scientist ran an editorial titled, R20;Bird Flu Outbreak Could Kill 1.5 Billion People.R21;477 [582] The top UN animal health official spoke of an R20;enormous sword of DamoclesR21; hanging over the world.478 [583] The director of the U.S. Centers for Disease Control and Prevention described it as the number-one health threat in the world and called it a R20;very ominous situation for the globe.R21;479 [584] Upon hearing the news, a Johns Hopkins University infectious disease specialist said, R20;I think people were delusionally hoping that it would never be transmitted from person to person and that would save us.R21;480 [585] The head of the World Health Organization in Asia held a press conference. He said: R20;We at WHO believe that the world is now in the gravest possible danger of a pandemic.R21;481 [586] The case compelled Thailand to launch a massive search for other cases of human spread, involving as many as one million volunteers going door-to-door. Thankfully, no further clusters of cases were found.482 [587] The virus still has some learning to do. Currently infection requires more than just a sneeze, a handshake, or a breath. So far, all officially suspected human-to-human transmissions have involved R20;close physical contact that included hugging, kissing, or cuddling the infected individuals to whom they were exposed.R21;483 [588] H5N1 is a gifted learner. Grasping the mutant swarm concept is critical to understanding how the virus got from strain A to Z+, and how it may get from Z+ to the pandemic strain. One individual may theoretically only be infected by a single virus particle, but one infected cell can start sloppily churning out millions of mutant progeny. H5N1 has a large graduating class. This dynamic mutant swarm breaks out and tries to reinfect other cells. The ones that are best at infecting further human cells are naturally selected to live long and prosper, passing on their genes. Only the strong survive; itR17;s a mammoth campaign of trial and error. Out of millions of competing viruses, the ones whose N spikes best worm their way through human mucus, the ones whose H spikes are best at unlocking human cells, the ones with NS1 proteins that best block human interferonR12;those are the ones that may best survive to make millions more in the next cell. By death, their hostsR17; lungs are saturated with more than a billion infectious viral doses per ounce of tissue.84 [589] R20;The clock keeps ticking,R21; Webster frets. R20;Every time this virus replicates, it makes mistakes. Sooner or later it will make the mistakes that will allow it to go human-to-human.R21;485 [590] Michael Osterholm, the director of the University of MinnesotaR17;s Center for Infectious Disease Research and Policy, compares H5N1 to a computer hacker. R20;WeR17;re providing that virus every opportunity. I mean every day, every second, is an evolutionary experiment going on in Asia. You know, itR17;s like a computer hacker that has a program that will figure out what a nine-digit security code is. If they have enough time and thereR17;s nothing to stop them, they can just run the program until all nine numbers work.R21;486 [591] Senate Majority Leader Bill Frist, M.D., compares H5N1 to a gambler. From the floor of the Senate, Frist explained: R20;Billions of mutations of the virus are occurring every day. With each mutation, the virus multiplies its odds of becoming transmissible from human to human. ItR17;s like pulling the lever on a Vegas slot machine over and over again. If you pull enough times, the reels will align and hit the jackpot.R21;487 [592] In the end, the virus that wins, the virus that succeeds in making the most copies of itself, is the virus that outperforms the others, passaging through thousands of individual cells to learn how best to infect the human species. It is that virus which gets breathed into the next personR17;s lungs and the process starts all over so the virus can get even smarter. Within a single individual, the virus is evolving, adapting, learning. It hits dead ends and tries something new, slowly notching up mutations that may lock into place the ability to effectively survive in, and transmit between, people. Every single person who gets infected presents a risk of spawning the pandemic virus. Describes one virologist, R20;YouR17;re playing Russian roulette every time you have a human infection.R21;488 [593] One day soon, experts fear, with more and more people becoming infected, the virus will finally figure out the combinationR12;the right combination of mutations to spread not just in one elevator or building, but every building, everywhere, around the globe. One superflu virus. ItR17;s happened before, and experts predict it may soon happen again. (c) BirdFluBook.com | Home [594] | Website by Lantern Media [595] Bird Flu - No Shot BirdFluBook.com [596] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [597] No Shot Outdated egg-based vaccine production Experts fear a modern pandemic could R20;eclipse 1918,R21;489 [598] but how could that be? We live in the age of modern medicine. We have vaccines and ventilators, antibiotics and antivirals, and the latest in medical technology. In 1918, they essentially didnR17;t even know what a virus was. One former president of the American Medical Association pointed out that the doctors of 1918 R20;knew no more about the flu than 14th-century Florentines had known about Black Death.R21;490 [599] Doctors could do little more than advise people to get on waiting lists for caskets.491 [600] Sadly, though, weR17;re not in much better shape today. Osterholm explains why 21st century medical advances are not expected to make a significant dent in the next pandemic: We really have no armamentarium today that is any different on a whole than what we had 100 years ago, at least in terms of whatR17;s available to the worldR17;s population. We have vaccines, we have some antivirals, but they will be in such insufficient quantities as to be what we like to say filling Lake Superior with a garden hose in overall impact.492 [601] Vaccines are the cornerstone in our fight against viral disease. By introducing a killed or weakened version of the target virus, we can prime our adaptive immune systems to recognize the attacker in the future and mobilize a more rapid response. Unfortunately, influenza viruses in general, and H5N1 in particular, mutate so rapidly that it is impossible to present the body with a perfect match. We can try making vaccines out of the current Z+ type, but any strain that eventually R20;goes humanR21; and triggers a pandemic may appear so differently to the body as to render the vaccine ineffective. Therefore R20;adequate supplies of vaccine will not be available at the start of a pandemic in any country,R21; concludes the World Health Organization.493 [602] From the moment the pandemic strain is recognized, mass production of a workable vaccine is expected to take six to eight months. In other words, please wait six to eight months for delivery. Webster asks: R20;How many people are going to die in the meantime?R21;494 [603] It may take a full year to produce enough for the United States,495 [604] and, by then, the pandemic may be over. With todayR17;s limited production capacity, we would not expect to be able to vaccinate more than about 14% of the worldR17;s population within a year of the pandemic striking.496 [605] The greatest problem then, according to the WHO, is production capacity.497 [606] The tenuousness of modern vaccine manufactureR12;even for seasonal influenza498 [607] R12;became clear in 2004, when half of the expected flu vaccine for the United States had to be tossed due to sterility concerns.499 [608] The director of the Center for Bioethics at the University of Pennsylvania suggests this precedent should cast doubt upon reassurances from politicians that vaccines could be distributed effectively during a pandemic. R20;Rhetoric about the orderly and carefully thought-out rationing of a scarce life-saving resourceR12;flu vaccineR12;turned [in 2004] into a cacophony of cheating, hoarding, lying and selfishness.R21;500 [609] A similar crisis occurred in 2000. As one member of the California Medical Association put it back then, R20;Right now in San Francisco, itR17;s easier to buy heroin off the street than to get a flu shot from your doctor.R21;501 [610] One of the main problems is the outdated method of vaccine production. According to the National Academy of ScienceR17;s Institute of Medicine, the basic technology for the production of influenza vaccine hasnR17;t changed in more than 50 years,502 [611] dating back to when slide rules were the state of the art for mathematical calculation.503 [612] This archaic method involves growing the virus for vaccine production in live fertile chicken eggs, a problem if youR17;re trying to grow a bird flu virus that may be 100% lethal to chickensR12;and their eggs. Researchers have since surmounted this hurdle, but there is no guarantee that an emerging pandemic strain could be cultivated fast enough.504 [613] Development of a vaccine for current H5N1 strains is underway in hopes that there will be some cross-reactivity to the pandemic strain once it emerges, but we shouldnR17;t hold our breath. R20;We are really talking about years before Joe Smith in New York can go to his health clinic and get a shot for avian flu,R21; said a WHO spokesperson.505 [614] Experts feel we may not have the luxury of that much time. R20;We have to get the message out loud and clear that vaccine will not save us,R21; emphasizes Osterholm. R20;We will have very little of it, and it will get here too late.R21;506 [615] (c) BirdFluBook.com | Home [616] | Website by Lantern Media [617] Bird Flu - Bitter Pill BirdFluBook.com [618] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [619] Bitter Pill Front page Washington Post headline Antibiotics may be even less help. We live in a global, just-in-time economy, which allows manufacturers worldwide to streamline their production to precisely meet demand, thereby reducing inventory warehousing costs and waste. The problem is that a single glitch in the supply chain can almost instantly dry up supply. Thus, even now, we have a shortage of seven major antibiotics and three pediatric chemotherapy drugs. During a crisis in which we shut down our borders, globalized supply chains will be shattered and vital goods like pharmaceuticals in general will be in short supply or unavailable.507 [620] Antibiotics only work against bacteria. Although they can be effective in treating secondary bacterial infections, they are useless against viral pneumonia. Antibiotics were useful during the 1957 and 1968 pandemics because these were essentially just bad flu seasons when more people than expected came down with the flu due to the novelty of the bird-human hybrid viruses. 1918 was different: Many people were killed by their own immune systems in the cytokine firestorm sparked by the virus.508 [621] Antibiotics may not have been much help in 1918,509 [622] and we may face the same situation with H5N1.510 [623] In the 1960s, though, a breakthrough was made. A new class of drugsR12;antiviral drugsR12;hit the market, drugs that could actually block influenza viruses from entering cells.511 [624] The medical community breathed a collective sigh of relief. The CDCR17;s report of the 1997 Hong Kong outbreak confidently declared, for example, R20;Two antiviral drugs, amantadine and rimantadine, inhibit replication of virtually all naturally occurring human and animal strains of influenza type A [influenza strains with pandemic potential] and therefore can be useful for prophylaxis and treatment of influenza A infections.R21;512 [625] Devastating news broke in June 2005. For years, Chinese chicken farmers had been slipping those very drugs into their chickensR17; water supply to prevent economic losses from bird flu. Because of this practice, the emerging H5N1 became resistant to these potentially life-saving drugs. R20;Bird Flu Drug Rendered Useless,R21; headlined The Washington PostR17;s exposé.513 [626] The scientific communityR17;s fears had been realized.514 [627] R20;In essence,R21; one expert wrote, R20;this finding means that a whole class of antiviral drugs has been lost as treatment for this virus.R21;515 [628] China learned it from us. The use of amantadine in the water supply of commercial poultry as prophylaxis against avian influenza was pioneered in the United States after the 1983 outbreak in Pennsylvania.516 [629] Even then it was shown that drug-resistant mutants arose within nine days of application.517 [630] Although Europe has banned the use of antibiotics of human importance in farm animals for non-treatment purposes since 1998, producers in the United States continue to legally spike farm animal feed with more than a dozen antibiotics. In fact, the Union of Concerned Scientists estimates that fully 70% of antimicrobials used in the United States are fed to farm animals for non-therapeutic purposes. U.S. poultry eat more than 10 million pounds of antibiotics a year, more than a 300% rise since the 1980s.518 [631] With few, if any, new classes of antibiotics in clinical development,519 [632] an expert on antibiotic resistance at the Institute for Agriculture and Trade Policy warned that R20;weR17;re sacrificing a future where antibiotics will work for treating sick people by squandering them today for animals that are not sick at all.R21;520 [633] Thankfully, in 1999, a new class of antivirals came onto the market, notably oseltamivir (brand name Tamiflu(R)).521 [634] Unfortunately, there is not enough to go around. Historically, it has been made in one plant, from one plant. One factory in Switzerland has made the entire world reserve of the drug from star anise, a plant in limited global supply. R20;ItR17;s not just about having a magic bullet,R21; Osterholm cautioned, R20;itR17;s whether you can make it and find enough guns from which to shoot it.R21;522 [635] The current U.S. stockpile covers less than 1% of the population,523 [636] and there is a long waiting list for new orders.524 [637] The Chinese poultry industryR17;s actions have created, as one worldR17;s authority on bird flu put it, a R20;very, very dangerousR21; situation.525 [638] R20;We are living in a brave new world where we only have one drug,R21; another expert told the G7+ Global Health Security Action Group.526 [639] While Tamiflu is relatively unavailable, expensive, and hard to make, amantadine, as described by National Institutes of Health director Anthony Fauci, is a R20;very cheap drug, a widely available drug, a drug of which there are ample supplies.R21;527 [640] Amantadine costs as little as $10 a pound;528 [641] Tamiflu, because itR17;s still under patent, costs closer to $10 a pill.529 [642] Even if there were enough Tamiflu, most developing nations could not afford it.530 [643] Tamiflu is also a relatively unstable compound, expiring after just a few years, which makes it difficult to stockpile. Amantadine, on the other hand, is adamantine; itR17;s sticking around. Researchers took amantadine that had already been sitting on the shelf for literally decades, then boiled it for a few hours. It still retained full antiviral activity.531 [644] R20;Thus,R21; the researchers concluded, R20;amantadine and rimantadine could be synthesized in large quantities and stored for at least one generation without loss of activity in preparation for the next influenza A pandemic in humans.R21;532 [645] Not anymore, though, thanks to global poultry industry practices.533 [646] Amantadine was no panaceaR12;it had rare but serious side effects, and resistance may well have developed with human use as well534 [647] R12;but it may have been our best bet,535 [648] a bet weR17;ve now gambled away. (c) BirdFluBook.com | Home [649] | Website by Lantern Media [650] Bird Flu - Profit Motive BirdFluBook.com [651] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [652] Profit Motive U.S. Army field hospital What about advances in medical technology? The immune systemR17;s attack on the lungs causes a condition called acute respiratory distress syndrome, a devastating, often lethal, inflammatory form of severe lung failure seen in other conditions such as extensive chemically seared lung burns.536 [653] Treatment involves paralyzing the patients, producing a drug-induced coma, and mechanically ventilating them with a tube down the windpipe connected to a breathing machine (ventilator). This allows doctors to increase the flow of oxygen while suctioning fluid from the lungs, a treatment unavailable in 1918. The mortality rates coming out of Asia, though, are not a function of outmoded medical facilities. Osterholm toured the facilities and was amazed at the care patients received. R20;Many of those patients get as good care as you are going to get at most medical centers in this country,R21; he said. R20;But they still crash and burnR12;the point being, the cytokine storm, even under the best of conditions, is extremely difficult. I donR17;t care if youR17;re in the intensive care unit at Johns Hopkins or the Mayo Clinic or in Hanoi. ItR17;s a very difficult clinical condition to manage.R21;537 [654] R20;In general terms,R21; Osterholm continued, R20;we are not much better able to handle acute respiratory distress syndrome, in any number of cases today, than we were in 1918.R21; R20;So,R21; he told a reporter, R20;do not go back and say, well, it is different today, it is not 1918. Unfortunately, folks, it is 1918 all over again, even from a clinical response standpoint.R21;538 [655] If it happens again, Osterholm concludes, R20;modern medicine has little in its arsenal to fight it.R21;539 [656] A former director of the National Institutes of Health describes how the scene is likely to look: R20;Hospital wards will be choked with thousands of victims young and old. They will be hooked up to respirators, lying in comas, and dying as their heart and blood vessels fail massively. Others will be waiting in the corridors.R21;540 [657] Fifty percent of those falling sick are dying despite our best treatments, and in the event of a pandemic, even those therapies wonR17;t be sufficiently available. There are only about 100,000 ventilators in all of AmericaR17;s hospitals, and 75,000 or so are in use at any given time for everyday medical care year round.541 [658] There are only nine major manufacturers of ventilators worldwide, each of which, according to a national marketing director, can only produce about a dozen a day. R20;They are usually built to order,R21; he says, R20;and it takes a couple of weeks to manufacture one.R21;542 [659] Experts like Irwin Redlener, the director of Columbia UniversityR17;s National Center for Disaster Preparedness, see the ventilator shortage as being emblematic of the countryR17;s overall lack of preparedness. R20;This is a life-or-death issue, and it reflects everything else thatR17;s wrong about our pandemic planning,R21; Redlener said.543 [660] Within days of a pandemic, ventilators will be just one of many pieces of medical equipment that would be in short supply with the collapse of global supply chains. R20;Throughout the crisis,R21; Osterholm wrote in the public policy journal Foreign Affairs, R20;many of these necessities would simply be unavailable for most health-care institutions.R21;544 [661] As things currently stand, says the American Hospital AssociationR17;s senior vice president for strategic policy planning, we will have no choice but to R20;learn to cope with 1950s medicine for a time.R21;545 [662] Forget ventilatorsR12;there arenR17;t enough hospital beds. Redlener describes insufficient hospital capacity as our R20;biggest weak link.R21;546 [663] Unlike most other health care systems in the world, health care in the United States is largely profit driven. The reconstruction of the U.S. medical system around managed care led to the closure of hundreds of hospitals across the United States,547 [664] leaving many cities with little surge capacity to deal with an abnormal influx of patients.548 [665] HMO corporate stock profiles can ill afford to provide extra beds and ventilators for some indeterminate future surge of patients.549 [666] A 2003 survey by the American College of Emergency Physicians (ACEP), for example, found that 90% of the countryR17;s 4,000 emergency departments were already seriously understaffed and overcrowded.550 [667] The founder of the ACEP disaster medicine section described emergency care in the United States as being R20;like a house of cards waiting for a big wind to collapse it.R21;551 [668] Just as visits to the nationR17;s emergency rooms are reaching an all-time high, according to the CDC, the number of emergency departments in the nation has actually decreased by 14% over the last decade or so.552 [669] In the winter of 2004, emergency rooms in 17 of the 20 major U.S. metropolitan areas had to go R20;on diversion,R21; meaning they literally had to close their doors and turn people away because they were so full.553 [670] R20;We [would] be caring for people in gymnasiums and community centers,R21; said Osterholm, R20;just like in 1918.R21;554 [671] The CDCR17;s top flu expert, Keiji Fukuda, elaborates in a New York Times interview: R20;The United States medical system has been moving toward fewer hospital beds, less unused capacity. This makes sense from a business standpoint.R21; His voice then reportedly dropped to a softer, sadder register. R20;I come from a generation of doctors who didnR17;t think of what we do as first and foremost a business. But I suppose weR17;re dinosaurs. We have to operate in the real world where medicine is run on a cost-benefit basis.R21;555 [672] According to a recent survey in the Economist, the United States was ranked 55th in the world in terms of acute care beds per capita,556 [673] comparable more to the third world than to Europe, which has about twice the number of population-adjusted beds.557 [674] Over the past generation, wrote the editor of Lancet, R20;the U.S. public health system has been slowly and quietly falling apart.R21;558 [675] There is also concern about severe staff shortages.559 [676] Clarified one system director of emergency and continuity management for a large hospital chain, R20;The question becomes not how many beds you have but how many beds you can staff.R21;560 [677] During the SARS crisis in Toronto, many health care workers didnR17;t turn up for work for fear of taking the infection home to their families. Indeed, almost half of the cases in the outbreak were health care workers, and two nurses and one doctor died.561 [678] A Johns Hopkins survey of public health employees in Maryland found that R20;nearly half of the local health department workers are likely not to report to duty during a pandemic.R21;562 [679] For more than a century, the American Medical Association code of ethics included a noble obligation that mirrored the Canadian Medical AssociationR17;s: R20;When pestilence prevails, it is their [physiciansR17;] duty to face the danger, and to continue their labours for the alleviation of suffering, even at the jeopardy of their own lives.R21; The AMA duty-to-care clause has since been removed.563 [680] According to the journal of the American Bar Association, though, 32 state governments are currently considering legislation that would effectively force health care workers to show up for work in a medical crisis by threatening to yank their licensure.564 [681] (c) BirdFluBook.com | Home [682] | Website by Lantern Media [683] Bird Flu - Population Bust BirdFluBook.com [684] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [685] Population Bust Population explosion A pandemic today could be many times worse than the pandemic of 1918, the worldR17;s greatest medical catastrophe. In 1918 we were, as a nation and as a people, much more self-sufficient.565 [686] With the corporate triumph of free trade, just-in-time inventory management and global supply chains now characterize all major economies and business sectors.566 [687] Economic analysts predict the pandemic would cause a global economic collapse unprecedented in modern history.567 [688] With the global population at an historical high, this could lead to unprecedented human suffering. A short 100,000 years ago, all members of the human race lived in eastern Africa.568 [689] The 6.5 billion people alive today represent roughly one out of every nine people who have ever inhabited the Earth.569 [690] In 1918, cities like London were smaller, with just over than one million residents. Today there are 26 megacities in the world, each with more than ten million people.570 [691] With this kind of tinder, experts like the WHOR17;s Klaus Stohr predict the pandemic will R20;explosivelyR21; hit world populations R20;like a flash flood.R21;571 [692] R20;The rapidity of the spread of influenza throughout a country is only limited by the rapidity of the means of transportation,R21; explained the 1918 New York State Health Commissioner.572 [693] Back then, the fastest way to cross the world was by steamship.573 [694] In the past, a trip around the world took a year; today we and our viruses can circle the globe in 24 hours.574 [695] The number of human globe-trotters now exceeds one billion people a year.575 [696] AIDS left Africa on an aircraft. So too may H5N1 leave Asia, only a plane ride away. Between record population levels and the unprecedented current speed, volume, and reach of global air travel, any pandemic virus could wreak unparalleled havoc.576 [697] H5N1, though, promises to be more than just any pandemic virus. In all of his more than 40 years working with influenza viruses, Robert Webster can state unequivocally, R20;This is the worst flu virus I have ever seen or worked with or read about.R21;577 [698] At a congressional briefing, Gregory A. Poland of the Mayo Clinic and the Infectious Diseases Society of America tried to get members of Congress to imagine the unimaginableR12;an H5N1 pandemic. R20;I want to emphasize the certainty that a pandemic will occur,R21; he began. R20;When this happens, time will be described, for those left living, as before and after the pandemic.R21;578 [699] The top virologist in Russia attempted to tally the worst-case scenario potential human death count: R20;Up to one billion people could die around the whole world in six monthsR30;. We are half a step away from a worldwide pandemic catastrophe.R21;579 [700] (c) BirdFluBook.com | Home [701] | Website by Lantern Media [702] Bird Flu - R20;Get rid of the R16;if.R17;This is going to occur.R21; BirdFluBook.com [703] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [704] R20;Get rid of the R16;if.R17;This is going to occur.R21; R12;NIH director Anthony Fauci580 [705] Dr. Frist: How would a nation react? In a talk at his alma mater, Harvard Medical School, Senate Majority Leader Frist described the horrors of 1918R12;at least 50 million dead from an R20;avianlikeR21; virus.581 [706] Frist asked: How would a nation so greatly moved and touched by the 3,000 dead of September 11th react to half a million dead? In 1918R11;1919 the mortality rate was between 2.5% and 5%, which seems merciful in comparison to the 55% mortality rate of the current avian flu. In just 18 months, this avian flu has killed or forced the culling of more than 100 million animals. And now that it has jumped from birds to infect humans in 10 Asian nations, how many human lives will it or another virus like it take? How, then, would a nation greatly moved and touched by 3,000 dead, react to 5 or 50 million dead?582 [707] Other public health authorities have expressed similar sentiments on a global scale. World Health Organization executive director David Nabarro was recently appointed the bird flu czar of the United Nations. At a press conference at UN headquarters in New York, Nabarro tried to impress upon journalists that R20;weR17;re dealing here with world survival issuesR12;or the survival of the world as we know it.R21;583 [708] R20;The reality is that if a pandemic hits,R21; explained the executive director of Trust for AmericaR17;s Health, a public health policy group, R20;itR17;s not just a health emergency. ItR17;s the big one.R21;584 [709] Similar fears reportedly keep U.S. Secretary of Health and Human Services Mike Leavitt awake at night. R20;ItR17;s a world-changing event when it occurs,R21; Leavitt said in an interview. R20;It reaches beyond health. It affects economies, cultures, politics and prosperityR12;not to mention human life, counted by the millions.R21;585 [710] Yes, but what are the odds of it actually happening? What are the odds that a killer flu virus will spread across the world like a tidal wave, killing millions? R20;The burning question is, will there be a human influenza pandemic,R21; Secretary Leavitt told reporters. R20;On behalf of the WHO, I can tell you that there will be. The only question is the virulence and rapidity of transmission from human to human.R21;586 [711] The Director-General of the World Health Organization concurred: R20;[T]here is no disagreement that this is just a matter of time.R21;587 [712] R20;The world just has no idea what itR17;s going to see if this thing comes,R21; the head of the CDCR17;s International Emerging Infections Program in Thailand said, but then stopped. R20;When, really. ItR17;s when. I donR17;t think we can afford the luxury of the word R16;ifR17; anymore. We are past R16;ifR17;s.R17;R21;588 [713] The Chief Medical Officer of Great Britain,589 [714] the Director-General of Health of Germany,590 [715] the director of the U.S. Centers for Disease Control,591 [716] the Senior United Nations Coordinator for Avian and Human Influenza,592 [717] and the director of the U.S. National Security Health Policy Center593 [718] all agree that another influenza pandemic is only a matter of time. As the director of Trust for AmericaR17;s Health put it, R20;This is not a drill. This is not a planning exercise. This is for real.R21;594 [719] (c) BirdFluBook.com | Home [720] | Website by Lantern Media [721] Bird Flu - R20;It is coming.R21; BirdFluBook.com [722] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [723] R20;It is coming.R21; R12;Lee Jong-wook, the late WHO Director-General595 [724] Dr. Lee Jong-Wook The National Academy of ScienceR17;s Institute of Medicine now describes a pandemic as R20;not only inevitable, but overdue.R21;596 [725] This is based in part on the understanding that there have been ten pandemics recorded since global travelers embarked approximately three centuries ago.597 [726] Pandemics average every 27.5 years,598 [727] with 39 years presented as the longest known interval between pandemics.599 [728] 2006 places us at year 37 since the pandemic of 1968. According to the director of the CDC, R20;It doesnR17;t take a scientist to appreciate that the clock is ticking, and that another pandemic is due.R21;600 [729] Said a WHO spokesperson, R20;All the indications are that we are living on borrowed timeR30;.R21;601 [730] A senior associate at the Center for Biosecurity lists the indications: R20;The lethality of the virus is unprecedented for influenza, the scope of the bird outbreak is completely unprecedented and the change that needs to happen to create a pandemic is such a small changeR12;it could literally happen any day.R21;602 [731] Never before has bird flu spread so far, so fast,603 [732] and the longer the virus circulates in poultry production systems, the higher the likelihood of additional human exposure.604 [733] Virology professor John Oxford explains: The problem is one chicken can contain hundreds of thousands of strains of H5N1. LetR17;s say there are a billion chickens in Asia and 10% are infectedR12;thatR17;s a vast population of viruses, more than the entire human population of the planet. Now letR17;s further suppose some of these strains have mutated so they can latch not only onto a chicken but onto you or me, but they cannot do it very efficiently. ThatR17;s the position we appear to be in. If a child catches the virus from a chicken they may transmit it to their mother, but the mother wonR17;t be able to go out and infect the grocer. At the moment itR17;s a slow greyhound of a virus. ItR17;s when it develops into a normal greyhound that weR17;re in for it.605 [734] But there are more than a billion chickens in Asia. In 1968, the year of the last pandemic, there were 13 million chickens in China. Now, there are more than 13 billion in mainland China alone. And since the time from hatching to slaughter is only a matter of weeks or months, depending on whether the chicken is raised for meat or eggs, there are multiple cycles of these billions passing through the system in the course of the year. Back then, there were 5 million pigs in China; now there are 500 million.606 [735] R20;High concentrations of animals,R21; concluded the International Food Policy Research Institute, R20;can become breeding grounds for disease.R21;607 [736] H5N1 may be here to stay. R20;This virus cannot now be eradicated from the planet,R21; said Center for Biosecurity director OR17;Toole. R20;It is in too many birds in too many places.R21;608 [737] On the contrary, the virus seems to be getting more entrenched. R20;If you described it as a war, weR17;ve been losing more battles than weR17;ve won,R21; a WHO spokesman told the Financial Times. R20;From a public health point of view, and an animal health point of view, this virus is just getting a stronger and stronger grip on the region.R21;609 [738] R20;ThatR17;s why every virologist in the world is flying around with his hair on fire,R21; says OR17;Toole.610 [739] In a tone uncharacteristic of international policy institutions, the UNR17;s Food and Agriculture Organization writes: R20;Over this bleak landscape sits a black cloud of fear that the virus might become adapted to enable human-to-human transmission and then spread around the globe.R21;611 [740] The urgency and alarm among those tracking H5N1R17;s building momentum is palpable.612 [741] R20;I feel it every day, and my staff feels it every day,R21; describes NIHR17;s Fauci.613 [742] R20;ItR17;s like watching a volcano getting ready to erupt,R21; described a spokesperson of the World Organization for Animal Health (known as OIE, for Office Internationale des Epizooties).614 [743] Helen Branswell of the Canadian Press, considered to be the worldR17;s leading journalist on bird flu,615 [744] has spent years researching pandemic influenza and has likely interviewed nearly everyone in the field. R20;A number, including leading influenza experts,R21; she reported, R20;told me they all suffer sleepless nights.R21;616 [745] R20;WeR17;re all holding our breath,R21; said Julie Gerberding, head of the CDC.617 [746] (c) BirdFluBook.com | Home [747] | Website by Lantern Media [748] Bird Flu - Two Minutes to Midnight BirdFluBook.com [749] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [750] Two Minutes to Midnight When is the pandemic going to strike? The experts are vague on this point: R20;probably sooner rather than later,R21;618 [751] R20;any time now,R21;619 [752] R20;this year or nextR21;620 [753] are common refrains. Some wonder why it hasnR17;t happened already.621 [754] R20;ItR17;s tough to make predictions,R21; said Yogi Berra, R20;especially about the future.R21; Some have attempted to take comfort in the fact that the virus has been in existence for almost ten years and hasnR17;t sparked a pandemic yet.622 [755] Evidence suggests, though, that the 1918 virus was R20;smoulderingR21; for at least 11 years before it went pandemic.623 [756] A WHO and USDA research team agree: R20;It is probably dangerous to rely on the R16;if it were going to happen it already would haveR17; argumentR30;.R21;624 [757] Even if greater numbers of people start falling ill, the virus may still need to fine-tune its human appetite. Historians have found evidence of suspicious outbreaks of severe respiratory illness in the year preceding the pandemic of 1918. R20;We think these outbreaks in these army camps started in 1917,R21; concluded one expert, R20;then it took another year of an extra few mutations before it really exploded into the great wide world.R21;625 [758] Gerberding told a meeting of the American Association for the Advancement of Science that H5N1 represented the R20;most important threatR21; the world is currently facing. She said, R20;I think we can all recognize a similar pattern probably occurred prior to 1918.R21;626 [759] Unlike annual seasonal influenza, which tends to strike the northern hemisphere in winter,627 [760] pandemics have been known to occur at any time of the year.628 [761] Although there does not seem to be a concrete seasonal pattern, based on an analysis of past pandemics, appearance in the summer was more common than the winter,629 [762] which may coincide with the placing of ducks onto ChinaR17;s flooded rice fields.630 [763] The increased poultry sales and mass travel in the days leading up to the Tet Lunar New Year festival (which starts February 9) may also be a high-risk time.631 [764] Experts admit that they really donR17;t know. R20;It would be irresponsible to say we are absolutely going to get there this year or next year because we just donR17;t understand virus evolution enough,R21; says one Harvard epidemiologist. R20;It is, I think, correct to say that we are in a period where the risk is growing and where itR17;s higher than weR17;ve ever known it to be.R21;632 [765] What most scientists do agree on is that each day brings us one day closer to the pandemic, though they admit it is unknown which virus will ultimately trigger the pandemic or how severe the next one will be. R20;With the advent of AIDS, avian flu, Ebola and SARS,R21; a Tulane researcher notes, R20;the question of what launches new epidemics and pandemics is extremely important. The somewhat shocking answer is that we actually know nothing about the factors that launch animal viruses into epidemics or pandemics.R21;633 [766] A few scientists have toyed with the idea of trying to find out. By mixing H5N1 and human influenza viruses together in a lab, one might be able to estimate how much time we might have left by identifying how many mutations H5N1 may be away from creating a pandemic strain. The World Heath Organization is cautious about this approach and has called for a formal scientific consensus, believing that global decisions that entail global risks require global review. For any one country to undertake the project on its own, WHOR17;s principal flu scientist Klaus Stohr said, R20;is like a decision to start testing nuclear weapons unilaterally.R21;634 [767] Proponents argue that any pandemic H5N1 virus they create would be sequenced, but then promptly be destroyed. With a genetic description of the virus, though, and the easy availability of its progenitors, it could be recreated. R20;You can destroy this virus,R21; one critic remarked, R20;but it will never really be gone.R21;635 [768] The Dutch scientist who proposed the original idea admitted, R20;You could create a monster. But itR17;s a monster that nature could produce as well.R21;636 [769] (c) BirdFluBook.com | Home [770] | Website by Lantern Media [771] Bird Flu - Flu YearR17;s Eve BirdFluBook.com [772] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [773] Flu YearR17;s Eve Los Alamos supercomputer simulation Once the pandemic hits, scientists disagree on how fast it will spread around the world. The WHO expects it could hit every country on Earth in a matter of weeks.637 [774] Others imagine it may take weeks just to break out of its presumed Asian country of origin.638 [775] Once it does get moving, though, some authorities suspect it will hit Western shores within one week.639 [776] Others argue one day.640 [777] Or 12 hours.641 [778] Once in a country like the United States, supercomputer simulations at the Los Alamos weapons lab show the virus blanketing the country R20;with remarkable speed and efficiency.R21;642 [779] In 1918, the entire Earth was engulfed within weeksR12;and that was before commercial airline travel.643 [780] In an attempt to model the spread of the 1997 Hong Kong outbreak (had it gone pandemic), scientists calculated how many travelers had passed through Hong KongR17;s Kai Tak Airport. During the two-month outbreak in Hong Kong in 1997, more than four million people left that single airport.644 [781] Viruses now travel at jet speed. The pandemic is expected to come in multiple waves. Based on prior pandemics, two or three waves of infection have been predicted, spaced several months apart, with each global surge of infection expected to last perhaps six to eight weeks.645 [782] The second wave may be deadlier than the first as the virus fine-tunes its killing power.646 [783] Imagine this scenario: R20;A gentleman checks into a four star Hong Kong hotel to attend a wedding. He seems to have a bad coldR12;coughing and sneezingR12;but actually has something much worse. The wedding ends. Guests depart. The virus coughed by one man spreads to five countries within 24 hours.R21;647 [784] This is actually the true story of SARS, the closest the world has come to a pandemic influenza-like scenario in recent years.648 [785] Within months, the virus spread to 30 countries on six continents.649 [786] The WHO Global Outbreak Alert and Response team later marveled, R20;A global outbreak was thus seeded from a single person on a single day on a single floor of a Hong Kong hotel.R21;650 [787] The transmission rate of SARS pales in comparison to influenza.651 [788] R20;The world was lucky with SARS,R21; a top expert explains. R20;It turned out to be a dachshund of a virus akin to smallpox, and not a sprinting greyhound likeR30;influenza.R21;652 [789] (c) BirdFluBook.com | Home [790] | Website by Lantern Media [791] Bird Flu - Catching the Flu BirdFluBook.com [792] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [793] Catching the Flu According to the WHOR17;s director of Communicable Diseases Surveillance and Response, R20;History has told us that no one can stop a pandemic.R21;653 [794] But this is the 21st century; with enough advanced warning couldnR17;t a smoldering pandemic be stamped out, or at least controlled? On April 1, 2005, President George W. Bush issued an executive order authorizing the use of quarantines inside the United States.654 [795] The man in charge of preparing America for the pandemic is the Secretary of Health and Human Services, Michael Leavitt. R20;We would do all we could to quarantine,R21; says Secretary Leavitt. R20;ItR17;s not a happy thought. ItR17;s something that keeps the President of the United States awake. It keeps me awake.R21;655 [796] This is a typical response, notes a medical anthropologist at the Center for Biosecurity, R20;Politicians will be under a lot of pressure to demonstrate that they are doing something.R21;656 [797] Experts fear that not only would quarantines be wholly impractical and ineffective, they may even make matters worse. The World Health Organization recommends against such measures in part given the impracticality of enforcement.657 [798] R20;It shows a fundamental lack of understanding of public health emergencies,R21; says a Federation of American Scientists spokesperson. R20;I would be fascinated to see whether the president has a plan to quarantine a city like Washington, D.C., New York or Boston with so many roads in or out.R21;658 [799] Following the 1916 polio epidemic in New York City, the head of the Health Department wrote that given the R20;countless instances of inconvenience, hardship, yes, real brutal inhumanity which resulted from the application of the general quarantine,R21;659 [800] it was no wonder that so many people R20;developed a most perverse ingenuity in discovering automobile detours.R21;6600 [801] The Federation of American Scientists spokesperson could not imagine how the quarantine could be enforced in this day and age. R20;Is he going to send in tanks and armed men?R21; he asked.661 [802] Perhaps. President Bush has since asked Congress to give him authority to call in the military to contain the outbreak.662 [803] This has some commentators worried. An op-ed in the Houston Chronicle asked, R20;If a health worker, drug addict or teenager attempted to break the quarantine, what would soldiers do? Shoot on sight?R21; Teenagers and health workers were found to be the prime violators of quarantine rules in Toronto during the SARS outbreak in 2003.663 [804] Stating the obvious in regard to the difference between stopping the 1997 Hong Kong outbreak among chickens and stopping a human outbreak, experts have written, R20;Slaughter and quarantine of people is not an optionR30;.R21;664 [805] R20;Even if it was possible to cordon off a city,R21; notes the Center for BiosecurityR17;s OR17;Toole, R20;that is not going to contain influenza.R21;665 [806] Based on failed historical attempts along with contemporary statistical models,666 [807] influenza experts are confident that efforts at quarantine R20;simply will not work.R21;667 [808] R20;I think it is totally unreasonable on the basis of every pandemic weR17;ve had,R21; remarked a physician and flu researcher who worked with flu patients as far back as the 1958 pandemic.668 [809] Experts consider quarantine efforts R20;doomed to failR21;669 [810] because of the extreme contagiousness of influenza,670 [811] which is a function of its incubation period and mode of transmission. SARS, in retrospect, was an easy virus to contain because people essentially became symptomatic before they became infectious.671 [812] People showed signs of the disease before they could efficiently spread it, so tools like thermal image scanners at airports to detect fever, or screening those with a cough, could potentially stem the spread of the disease.672 [813] The influenza virus, however, gets a head start. The incubation period for influenza, the time between when you get infected and when you actually start showing the first symptoms of disease, can be up to four days long.673 [814] During this time, we are both infected and infectious. Just as those with HIV can spread the virus though they may appear perfectly healthy, at least 24 hours before any flu symptoms arise we may be exhaling virus with every breath.674 [815] As many as half of those infected may never show symptoms at all, but may still shed virus to others.675 [816] Some respiratory diseases seem only to be spread by droplets of mucus and therefore are not airborne in the truest sense. These aerosolized globs of mucusR12;though tinyR12;eventually settle to the floor and are not spread very far. Bird flu, on the other hand, can truly take wing. Influenza viruses in general, though predominantly spread by larger droplets, may also travel on microscopic residual specks of evaporated droplets less than a few millionths of a meter in diameter. These R20;droplet nucleiR21; can float suspended in air like particles of perfume676 [817] and hence may spread through ventilation systems.677 [818] Some investigators have even issued the dubious speculation that airborne viral transmission of influenza can occur over thousands of miles on intercontinental wind currents driven by low pressure weather fronts.678 [819] Regardless, influenza cannot be stopped by quarantine. (c) BirdFluBook.com | Home [820] | Website by Lantern Media [821] Bird Flu - Boots on the Ground BirdFluBook.com [822] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [823] Boots on the Ground Quarantines may make things worse. The detainment, isolation, and stigma associated with quarantine tend to dissuade communities from the timely reporting of outbreaks. Sending soldiers to quarantine large numbers of people may even create panic and cause people to flee, further spreading the disease. During the SARS epidemic, for example, rumors that Beijing would be quarantined led to 250,000 people pouring out of the city that night.679 [824] Throughout history, according to the Institute of Medicine, R20;for the most part quarantine policies did more harm than good.R21;680 [825] Irwin Redlener, associate dean of Columbia UniversityR17;s Mailman School of Public Health and director of its National Center for Disaster Preparedness, called the presidentR17;s suggestion to use the military to cordon off communities stricken by disease an R20;extraordinarily draconian measure.R21; R20;The translation of this,R21; Redlener told the Washington Post, R20;is martial law in the United States.R21;681 [826] The presidentR17;s proposal drew rancor from both ends of the political spectrum. The conservative Cato Institute joined George Mason UniversityR17;s Mercatus Center682 [827] in warning that Bush risks undermining R20;a fundamental principle of American law.R21;683 [828] The Posse Comitatus Act of 1878 has effectively barred the military from playing a policing role on U.S. soil. R20;That reflects AmericaR17;s traditional distrust of using standing armies to enforce order at home, a distrust thatR17;s well justified,R21; the InstituteR17;s website reads. Since soldiers are not trained as police officers, the Cato Institute fears that putting them in charge of civilian law enforcement R20;can result in serious collateral damage to American life and liberty.R21;684 [829] The former editor of New Left Review and acclaimed author of City of Quartz, Mike Davis is also critical of militarizing the pandemic response. Davis is skeptical that BushR17;s seeming one-size-fits-all solution to national emergencies is the best approach.685 [830] He asks, R20;[I]s America going to become one single huge squalid Superdome under martial law if there were an avian flu epidemic?R21;686 [831] After the September 11 attacks, FEMAR12;the Federal Emergency Management AgencyR12;was folded into the Department of Homeland Security. According to an emergency management expert at the Institute for Crisis, Disaster and Risk Management at George Washington University, this move R20;downgradedR21; FEMA from being a well-functioning small independent agency in the R17;90s to being R20;buried in a couple of layers of bureaucracy.R21; One former FEMA director testified before Congress in 2004: I am extremely concerned that the ability of our nation to prepare for and respond to disasters has been sharply eroded. I hear from emergency managers, local and state leaders, and first responders nearly every day that the FEMA they knew and worked well with has now disappeared. In fact one state emergency manager told me, R20;It is like a stake has been driven into the heart of emergency management.R21;687 [832] His fears were realized a year later with the response to Katrina, which, read one USA Today editorial, R20;was nearly as disastrous as the hurricane itself.R21;688 [833] Bush has since handed authority for coordinating the pandemic response to the same agency that handled Katrina, the Department of Homeland Security. In a press article, R20;WhoR17;s in Charge If Bird Flu StrikesR12;Docs or Cops?,R21; Georges Benjamin, executive director of the American Public Health Association (and MarylandR17;s chief health officer during the 2001 anthrax attacks) is quoted as saying that Homeland Security has neither the infrastructure nor the technical expertise to handle such a task. Traditionally, the federal health establishmentR12;the U.S. Public Health Service, the Centers for Disease Control and Prevention, and other health agenciesR12;has been considered the R20;primary federal agencyR21; in a national health emergency. In the case of the pandemic, though, the Department of Homeland Security has now assumed responsibility.689 [834] Emergency management authorities are troubled by the new arrangement. ItR17;s hard for experts like the chief of emergency medicine at Emory to imagine how Homeland Security could come up to speed almost from scratch on a complex issue like epidemic disease. R20;Pandemic flu is a naturally occurring health threat of the first order,R21; he said, R20;and the people who need to be at the center of that should be health care professionals first and foremost.R21; Benjamin agrees. R20;[A]t the end of the day,R21; he said, R20;the command decisions for this ought to be made by public health practitioners.R21;690 [835] For that matter, according to the dean of the Johns Hopkins Bloomberg School of Public Health, R20;ThereR17;s a very intense malaise and demoralization among the CDC staffR21; under Bush.691 [836] Allegations of White House cronyismR12;where friendship and loyalty are said to trump competence and qualificationsR12;took on a life-and-death quality with the resignation of FEMA director Michael Brown.692 [837] Similar charges have been made against BushR17;s appointed point person for the pandemic, Stewart Simonson. Like Michael Brown, whose qualifications to run the nationR17;s emergency response agency evidently included a past stint as Commissioner of the International Arabian Horse Association, Simonson is no expert in public health or emergency preparedness. Though he was appointed assistant secretary for Public Health Emergency Preparedness, Simonson has been regarded by some as just another lawyer pal of the administration. Before he was put in charge of protecting the nation from bird flu, he was corporate secretary and counsel for AMTRAK. During an April 2005 Homeland Security Subcommittee hearing, two Republican Senators concerned about the countryR17;s preparedness for a pandemic asked Simonson a question about the process for acquiring the influenza vaccine. Simonson replied, R20;WeR17;re learning as we go.R21;693 [838] Simonson resigned in March 2006.694 [839] Business WeekR17;s bird flu cover story, R20;Hot Zone in the Heartland,R21; featured Osterholm contrasting Katrina with the prospect of a pandemic. R20;The difference between this and a hurricane is that all 50 states will be affected at the same time,R21; said Osterholm. R20;And this crisis will last a year or more. It will utterly change the world.R21;695 [840] Even those sympathetic to the administration have cast doubt on its abilities to manage the crisis. Colonel Lawrence Wilkerson, for example, Colin PowellR17;s right-hand man at the State Department, recently said, R20;If something comes along that is truly seriousR30;like a major pandemic, you are going to see the ineptitude of this government in a way that will take you back to the Declaration of Independence.R21;696 [841] (c) BirdFluBook.com | Home [842] | Website by Lantern Media [843] Bird Flu - Emerging Infectious Disease BirdFluBook.com [844] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [845] Emerging Infectious Disease Emerging and re-emerging infectious diseases H5N1 is one of many new human viruses arising from the animal world in recent years. In 1948, the U.S. Secretary of State pronounced that the conquest of all infectious diseases was imminent.697 [846] Twenty years later, victory was declared by the U.S. Surgeon General: R20;The war against diseases has been won.R21; But as the chair of Medical Microbiology at the University of Edinburgh wrote in retrospect, R20;He was spectacularly wrong.R21;698 [847] The Institute of Medicine calls the post-WWII period the R20;era of complacency.R21;699 [848] The overconfidence of the time was understandable. We had conquered polio, nearly eradicated smallpox, developed childhood vaccinations, and assembled an arsenal of more than 25,000 different R20;miracle drugR21; antibiotic preparations.700 [849] Even Nobel Laureates were seduced into the heady optimism. To write about infectious disease, one Nobel-winning virologist wrote in the 1962 text Natural History of Infectious Disease, R20;is almost to write of something that has passed into history.R21; R20;[T]he most likely forecast about the future of infectious disease,R21; he pronounced, R20;is that it will be very dull.R21;701 [850] The year smallpox was declared history, a virus called human immunodeficiency virus began its colonization of Africa and the world with HIV/AIDS.702 [851] In some countries, the prevalence of HIV now exceeds 25% of the adult population.703 [852] The global efforts sparked by the WHO decision to R20;eliminate all malaria on the planetR21;704 [853] succeeded, as another Nobel Laureate put it, R20;in eradicating malariologists, but not malaria.R21; The malaria parasites are now antibiotic-resistant, and the mosquitoes carrying them are insecticide-resistant as well.705 [854] R20;Even the diseases once thought subdued,R21; the WHO finally had to concede, R20;are fighting back with renewed ferocity.R21;706 [855] Infectious disease remains the number-one killer of children worldwide.707 [856] ItR17;s getting worse.708 [857] R20;We claimed victory too soon,R21; said the co-chair of Yale UniversityR17;s committee on emerging infections. R20;The danger posed by infectious diseases has not gone away. ItR17;s worsening.R21;709 [858] After decades of declining infectious disease mortality in the United States, the trend has reversed over the last 30 years.710 [859] The number of Americans dying from infectious diseases started going back up.711 [860] A bitter pill of a joke circulates among infectious disease specialists: R20;The 19th century was followed by the 20th century, which was followed by theR30;19th century.R21;712 [861] The vice chair of the U.S. National Foundation for Infectious Diseases was asked, R20;Are we having more plagues?R21; R20;The answer is an unequivocal yes,R21; he replied. R20;These plagues are coming back with greater fury and in much greater profusion because theyR17;re killing more people than they did in centuries gone by.R21;713 [862] The concept of R20;emerging infectious diseasesR21; has changed from a mere curiosity in the field of medicine to an entire discipline.714 [863] As recorded by the U.S. National Library of Medicine, in excess of five times more medical journal articles have been written on emerging infectious diseases in the last four years than in the previous century.715 [864] Within recent years, emerging diseases have been moving to center stage in human medicine.716 [865] Since about 1975,717 [866] previously unknown diseases have surfaced at a pace unheard of in the annals of medicine718 [867] R12;more than 30 new diseases in 30 years, most of them newly discovered viruses.719 [868] What is going on? Why is it getting worse? To answer that question, we first have to consider where these diseases are coming from, since they have to come from somewhere. In other words, from where do emerging diseases emerge? An increasingly broad consensus of infectious disease specialists have concluded that R20;nearly allR21; of the increasingly frequent emergent disease episodes in the United States and elsewhere over the past few years have come to us from the animal world.720 [869] (c) BirdFluBook.com | Home [870] | Website by Lantern Media [871] Bird Flu - Their Bugs Are Worse Than Their Bite BirdFluBook.com [872] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [873] Their Bugs Are Worse Than Their Bite Almost by definition, R20;novelR21; viruses tend to come from other species.721 [874] In 1959, the World Health Organization defined the term R20;zoonosisR21; to describe this phenomenon,722 [875] from the Greek zoion for R20;animalR21; and nosos for R20;disease.R21; Most emerging infections are RNA viruses such as Ebola, HIV, or influenza723 [876] R12;not surprising, given their ability to mutate rapidly, evolve, and adapt to new hosts.724 [877] Although many doctors of today learned in their medical school textbooks that viruses were species-specific and therefore couldnR17;t jump from animals to people,725 [878] we now know that viruses are, as the Mayo Clinic describes, R20;masters of interspecies navigation.R21;726 [879] The exact proportion of emerging human diseases that have arisen from (other) animals is unknown. In 2004, the director of the CDC noted that R20;11 of the last 12 emerging infectious diseases that weR17;re aware of in the world, that have had human health consequences, have probably arisen from animal sources.R21;727 [880] An editorial in Lancet published the same year insisted that R20;[a]ll human diseases to emerge in the past 20 years have had an animal sourceR30;.R21;728 [881] In any case, experts agree that itR17;s a sizeable majority.729 [882] Eleven out of the top 12 most dangerous bioterrorism agents are zoonotic pathogens as well.730 [883] The Institute of Medicine published a report on the factors implicated in the emergence of disease in the United States. R20;The significance of zoonoses in the emergence of human infections,R21; it concluded, R20;cannot be overstated.R21;731 [884] According to the World Health Organization, the increasing numbers of animal viruses jumping to humans is expected to continue.732 [885] The zoonotic virus pool is by no means exhausted.733 [886] R20;If you look at the animal kingdomR12;from goats, sheep, camels, poultry, all fish, just about any animal you can nameR12;they [each] have probably 30 or 40 major diseases,R21; notes the WHO expert who led the fight against SARS. R20;So the possibility for exposure is huge.R21;734 [887] Estimates as to the number of zoonotic diseases run into the thousands.735 [888] R20;For every virus that we know about, there are hundreds that we donR17;t know anything about,R21; said one professor of tropical medicine at Tulane who studies emerging viruses in Africa. R20;Most of them,R21; he said, R20;we probably donR17;t even know that theyR17;re out there.R21;736 [889] Transmissions of disease from animal to person are not new.737 [890] Most of the human infectious diseases that exist today originally came from animals.738 [891] Many of humanityR17;s greatest scourgesR12;including influenzaR12;can be traced back thousands of years to the domestication of animals.739 [892] (c) BirdFluBook.com | Home [893] | Website by Lantern Media [894] Bird Flu - R20;Most and probably all of the distinctive infectious diseases of civilization have been transferred to human populations from animal herds.R21; BirdFluBook.com [895] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [896] R20;Most and probably all of the distinctive infectious diseases of civilization have been transferred to human populations from animal herds.R21; R12;William H. McNeill, Plagues and Peoples740 [897] HumanityR17;s biblical R20;dominion over the fish of the sea and over the birds of heaven; and every living thing that moved upon the earthR21; has unleashed a veritable PandoraR17;s ark full of humankindR17;s greatest killers.741 [898] Some diseases such as herpes and shingles seem to have always been with us, passed down the evolutionary chain. But most modern human infectious diseases were unknown to our hunter and gatherer ancestors.742 [899] Early humans may have suffered sporadic cases of animal-borne diseases such as anthrax from wild sheep or tularemia (R20;rabbit skinnerR17;s diseaseR21;) from wild rabbits,743 [900] but the domestication of animals triggered what the director of HarvardR17;s Center for Health and the Global Environment called the mass R20;spilloverR21; of animal disease into human populations.744 [901] Archeological evidence suggests that small, nomadic groups hardly suffered from contagious disease. With the advent of agriculture, though, communities settled and grew in relatively fixed locations, increasing their close exposure to their own waste and reservoirs of disease. Populations that domesticated only plants became more exposed to the few diseases they already harbored, but it was the domestication of animals that brought people in contact with a whole new array of pathogenic germs.745 [902] Epidemic diseases tend to be harbored only by those animal species that herd or flock together in large numbers. This concentration allows for the evolution and maintenance of contagious pathogens capable of rapidly spreading through entire populations. Unfortunately, this same qualityR12;the herd instinctR12;is what makes these animals particularly desirable for domestication. Domestication brought these animals once appreciated mainly from afar (along with their diseases) into close proximity and density with human settlements. As a zoonoses research team concluded, R20;The spread of microbes from animals to humans was then inevitable.R21;746 [903] Tuberculosis, R20;the captain of all these men of death,R21;747 [904] is thought to have been acquired through the domestication of goats.748 [905] In the 20th century, tuberculosis (TB) killed approximately 100 million people.749 [906] Today, tuberculosis kills more people than ever beforeR12;millions every year.750 [907] The World Health Organization declared tuberculosis a global health emergency in 1993 and estimates that between 2000 and 2020, nearly one billion people may be newly infected. What started out in goats now infects one-third of humanity.751 [908] Domesticated goats seemed to have beaten domesticated cattle to the punch. Between 1850 and 1950, bovine tuberculosis, acquired mostly by children drinking unpasteurized milk, was responsible for more than 800,000 human deaths in Great Britain alone.752 [909] Interestingly, it can go both ways. The British Journal of Biomedical Science recounts that dozens of cases of bovine TB were traced back to a R20;curious farm-worker practice of urinating on the hay, perhaps on the folklore premise that the salts in urine are beneficial to the cattle.R21; Of course when it turns out the workers have genitourinary tuberculosis infections, itR17;s not so beneficial.753 [910] Bovine tuberculosis continues to infect milk-drinking children to this day. In a study published in the American Academy of Pediatrics journal in 2000, doctors tested children with tuberculosis in San Diego and found that one-third of the tuberculosis wasnR17;t human. One in three of the children was actually suffering from tuberculosis caught not from someone coughing on them, but, the researchers suspect, from drinking inadequately pasteurized milk from an infected cow. The investigators conclude, R20;These data demonstrate the dramatic impact of this underappreciated cause of zoonotic TB on U.S. children.R21;754 [911] Measles is thought to have come from domesticated cows, a mutant of the bovine rinderpest virus. The measles virus has so successfully adapted to humans that cattle canR17;t get measles and we canR17;t get rinderpest. Only with the prolonged intimate contact of domestication was the rinderpest virus able to mutate enough to make the jump.755 [912] Though now considered a relatively benign disease, in roughly the last 150 years, measles has been estimated to have killed about 200 million people worldwide.756 [913] These deaths can be traced to the taming of the first cattle a few hundred generations ago.757 [914] Smallpox also may have been caused by a mutant cattle virus.758 [915] We domesticated pigs and got whooping cough, domesticated chickens and got typhoid fever, and domesticated ducks and got influenza.759 [916] The list goes on.760 [917] Leprosy came from water buffalo,761 [918] the cold virus from cattle762 [919] or horses.763 [920] How often did wild horses have opportunity to sneeze into humanityR17;s face until they were broken and bridled? Before then, the common cold was presumably common only to them. New zoonotic infections from domesticated farm animals continue to be discovered. The 2005 Nobel Prize in Medicine was awarded to the scientists who discovered in 1982 that bacteria living in the human stomach, which they called Helicobacter pylori, caused stomach cancer and the vast majority of peptic ulcers worldwide.764 [921] Roughly half of the worldR17;s population is now infected.765 [922] This ulcer-causing bacteria is thought to have originated in sheepR17;s milk, but is now spread person to person via oral secretionsR12;saliva or vomitR12;or perhaps, like cholera, the fecal-oral route due to poor hand washing following defecation. What has become probably the most common chronic infection afflicting humanity,766 [923] according to the CDC, came about because humanity started to drink the milk of another species thousands of years ago.767 [924] A recent addition to the list of infectious farm animal bacteria is a cousin of H. pylori, known as Helicobacter pullorum (from the Latin pullus for R20;chickenR21;),768 [925] infecting a large proportion of chicken meat. H. pullorum is thought to cause a diarrheal illness in people who contract it through the consumption of improperly cooked chicken fecal matter.769 [926] Yet another newly described fecal pathogen, hepatitis E, is one of the latest additions to the family of hepatitis viruses. It can cause fulminating liver infection in pregnant women, especially during the third trimester, with a mortality rate of up to 20%. Scientists began to suspect that this virus was zoonotic when they found it rampant in North America commercial pork operations.770 [927] Direct evidence of cross-species transmission was obtained in 2003.771 [928] Unlike a disease like trichinosis, which humans only get by eating improperly cooked pork, once a disease like hepatitis E crosses the species line, it can then be spread person to person. Between 1-2% of blood donors in the United States have been found to have been exposed to this virus.772 [929] (c) BirdFluBook.com | Home [930] | Website by Lantern Media [931] Bird Flu - R20;Wherever the European has trod, death seems to pursue the aboriginal.R21; BirdFluBook.com [932] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [933] R20;Wherever the European has trod, death seems to pursue the aboriginal.R21; R12;Charles Darwin, 1836773 [934] UCLA professor Jared Diamond explored how pivotal the domestication of farm animals was in the course of human history and medicine in his Pulitzer Prize-winning book Guns, Germs, and Steel. In the chapter R20;Lethal Gift of Livestock,R21; he argues convincingly that the diseases we contracted through the domestication of animals may have been critical for the European conquest of the Americas in which as many as 95% of the natives were decimated by plagues the Europeans brought with them. Natives had no prior exposure or immunity to diseases like tuberculosis, smallpox, and measles. Parallels were seen throughout the world with single missionaries unintentionally exterminating the entire target of their religious zeal with one of livestockR17;s R20;lethal gifts.R21;774 [935] Why didnR17;t the reverse happen? Why didnR17;t Native American diseases wipe out the landing Europeans? Because there essentially werenR17;t any epidemic diseases. Medical historians have long conjectured that the reason there were so many plagues in Eurasia was that R20;crowdR21; diseases required large, densely-populated cities, unlike the presumed small tribal bands of the Americas. But that presumption turned out to be wrong. "New world" cities like Tenochtitlan were among the most populous in the world.775 [936] The reason the plagues never touched the Americas is that there were far fewer domesticated herd animals. There were buffalo, but no domesticated buffalo, so there was presumably no opportunity for measles to arise. No pigs, so no pertussis; no chickens, so no Typhoid Marys. While people died by the millions of killer scourges like tuberculosis in Europe, none were dying in the R20;new worldR21; because no animals like goats existed to domesticate. The last ice age killed off most of the easily domesticated species in the western hemisphere, such as American camels and horses, leaving the indigenous population only animals like llamas and guinea pigs to raise for slaughter, neither of whom seem to carry much potential for epidemic human disease.776 [937] (c) BirdFluBook.com | Home [938] | Website by Lantern Media [939] Bird Flu - The Plague Years BirdFluBook.com [940] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [941] The Plague Years According to the Smithsonian Institution, there have been three great epidemiological transitions in human history. Epidemiology is the study of the distribution of epidemic disease. The first era of human disease began with the acquisition of diseases from domesticated animals. Entire ancient civilizations fell prey to diseases birthed in the barnyard.777 [942] The second era came with the Industrial Revolution of the 18th and 19th centuries, resulting in an epidemic of the so-called R20;diseases of civilization,R21; such as cancer, heart disease, stroke, and diabetes.778 [943] Chronic diseases now account for seven out of ten deaths in the United States779 [944] and the majority of deaths worldwide.780 [945] Thankfully, these diseases are considered R20;largely preventableR21; through changes in diet and lifestyle.781 [946] We are now entering the third age of human disease, which started around 30 years agoR12;the emergence (or re-emergence) of zoonotic diseases.782 [947] Medical historians describe these last few decades as the age of R20;the emerging plagues.R21;783 [948] Never in medical history have so many new diseases appeared in so short a time. The trend is continuing. We may soon be facing, according to the U.S. Institute of Medicine, a R20;catastrophic storm of microbial threats.R21;784 [949] Most of these new diseases are coming from animals, but animals were domesticated 10,000 years ago. Why now? What is responsible for this recent fury of new and re-emerging zoonotic disease? Starting in the last quarter of the 20th century, medicine has been examining emerging disease within an increasingly ecological framework. The director of AustraliaR17;s National Centre for Epidemiology and Population Health says we shouldnR17;t be surprised by the recent explosion in zoonotic disease given recent environmental changes. R20;We need to think ecologically,R21; he said. R20;These viruses are trying to evolve.R21;785 [950] Just as plants and animals in the wild try to adapt to new environments to spread their species, viruses also expand to exploit any newly exposed niches. R20;Show me almost any new infectious disease,R21; said the executive director of the Consortium of Conservation Medicine, R20;and IR17;ll show you an environmental change brought about by humans that either caused or exacerbated it.R21;786 [951] To quote the comic-strip character Pogo, R20;We have met the enemy and he is us.R21;787 [952] Two centuries ago, Edward Jenner, the founder of modern vaccines, proposed that the R20;deviation of man from the state in which he was originally placed by nature seems to have proved him a prolific source of diseases.R21;788 [953] This observation dates back to the 2nd century, when Plutarch argued that new classes of diseases followed profound changes in the way we live.789 [954] The same can be said for animals. R20;Something is not right,R21; reflects Professor Shortridge. R20;Human population has exploded, we are impinging on the realms of the animals more and more, taking their habitats for ourselves, forcing animals into ever more artificial environments and existences.R21;790 [955] We are changing the way animals live. According to the World Health OrganizationR17;s coordinator for zoonoses control, R20;The chief risk factor for emerging zoonotic diseases is environmental degradation by humansR30;.R21;791 [956] This includes degradation wrought by global climate change, deforestation, and, as described by the WHO, R20;industrialization and intensification of the animal production sector.R21;792 [957] Along with human culpability, though, comes hope. If changes in human behavior can cause new plagues, changes in human behavior may prevent them in the future.793 [958] (c) BirdFluBook.com | Home [959] | Website by Lantern Media [960] Bird Flu - AIDS: A Clear-Cut Disaster BirdFluBook.com [961] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [962] AIDS: A Clear-Cut Disaster Bushmeat In 1933, Aldo Leopold, the R20;founding father of wildlife ecology,R21;794 [963] declared, R20;The real determinants of disease mortality are the environment and the population,R21; both of which he said were being R20;doctored daily, for better or for worse, by gun and axe, and by fire and plow.R21;795 [964] Since Leopold wrote those lines, more than half of the EarthR17;s tropical forests have been cleared.796 [965] According to the UN Food and Agriculture Organization, expanding livestock production is one of the main drivers of tropical rainforest destruction, particularly in Central and South America.797 [966] This R20;hamburgerizationR21; of the rainforests sets the stage for disease emergence and transmission in a number of ways. Many disease-carrying mosquitoes prefer to breed out in the open along partially cleared forest fringes, rather than deep in the forest.798 [967] When livestock are grazed on the cleared land, the animals serve as warm-blooded meals for disease vectors like mosquitoes and biting flies, which may become so numerous they seek out blood meals from humans.799 [968] Clear-cutting can also create a windfall for disease-bearing rodents. With leading cattle-producing nations at war during WWII, Argentina took advantage of this situation by dramatically expanding its beef industry at the expense of its forests. The ensuing explosion in field mouse populations led to the surfacing of the deadly Junin virus, the cause of Argentine hemorrhagic fever,800 [969] a disease characterized in up to one-third of those infected by extensive bleeding, shock, seizures, and death.801 [970] On cleared cropland, unprotected agriculture workers are on the front line, as harvesting machinery produces clouds of potentially infectious dust and aerosols of blood from animals crushed in the combines.802 [971] This scenario was repeated as humankind intruded into other remote virgin forests. In Bolivia, we discovered the Machupo virus, or, rather, the Machupo virus discovered us. In Brazil, we uncovered the Sabia virus. The Guanarito virus resulted in Venezuelan hemorrhagic fever. R20;Mostly these days,R21; wrote one prominent medical microbiologist, R20;it is manR17;s intrusion on the natural environment which is the all-important key to emerging viruses.R21;803 [972] Inroads into AfricaR17;s rainforests exposed other hemorrhagic fever virusesR12;the Lassa virus, Rift Valley Fever, and Ebola. According to the WHO, all dozen or so804 [973] hemorrhagic fever viruses so far unearthed have been zoonotic, jumping to us from other animals.805 [974] R20;These zoonotic viruses seem to adhere to the philosophy that says, R16;I wonR17;t bother you if you donR17;t bother me,R17;R21; explained a former Nature editor.806 [975] But then, she said, as people began R20;pushing back forests, or engaging in agricultural practices that are ecologically congenial to viruses, the viruses could make their way into the human population and multiply and spread.R21;807 [976] Radical alterations of forest ecosystems can be hazardous in the Amazon Basin or the woods of Connecticut, where Lyme disease was first recognized in 1975. Since then, the disease has spread across all 50 states808 [977] and affected an estimated 100,000 Americans.809 [978] Lyme disease is spread by bacteria-infested ticks that live on deer and mice, animals with whom people have always shared wooded areas. What happened recently was suburbia. Developers chopped AmericaR17;s woods into subdivisions, scaring away the foxes and bobcats who had previously kept mouse populations in check. Animal ecologists recover some seven times more infected ticks from 1- and 2-acre woodlots than lots of 10 to 15 acres. The pioneer in this area concluded, R20;YouR17;re more likely to get Lyme disease in Scarsdale than the Catskills.R21;810 [979] The forests of Africa were not, however, cut down to make golf courses. The inroads into AfricaR17;s rainforests were logging roads, built by transnational timber corporations hacking deep into the most remote regions of the continent. This triggered a mass human migration into the rainforests to set up concessions to support the commercial logging operations. One of the main sources of food for these migrant workers is bushmeatR12;wild animals killed for food.811 [980] This includes upwards of 26 different species of primates,812 [981] including thousands of endangered great apesR12;gorillas and chimpanzeesR12;who are shot, butchered, smoked, and sold as food.813 [982] To support the logging industry infrastructure,814 [983] a veritable army of commercial bushmeat hunters are bringing the great apes to the brink of extinction.815 [984] R20;These logging companies have been promoting the bushmeat trade themselves,R21; claims one expert. R20;It is easier to hand out shotgun shells than to truck in beefR30;.R21;816 [985] The reason french fries can be eaten with abandon without fear of coming down with potato blight is that pathogens adapted to infect plants donR17;t infect people. The evolutionary span is too wide. Eating animals can certainly give us animal diseases, but near-universal taboos against cannibalism have well served the human race by keeping more closely adapted viruses off our forks.817 [986] Having finally sequenced the genome of the chimpanzee, though, scientists realize we may share more than 95% of our DNA with our fellow great apes.818 [987] R20;Darwin wasnR17;t just provocative in saying that we descend from the apesR12;he didnR17;t go far enough,R21; one primatologist said. R20;We are apes in every wayR30;.R21;819 [988] By cannibalizing our fellow primates, we are exposing ourselves to pathogens particularly fine-tuned to human primate physiology. Recent human outbreaks of Ebola, for example, have been traced to exposure to the dead bodies of infected great apes hunted for food.820 [989] Ebola, one of humanityR17;s deadliest infections, is not efficiently spread, though, compared to a virus like HIV. 1981 brought us Ronald Reagan taking the oath, MTVR17;s first broadcast, Pacman-mania, and Raiders of the Lost Ark. In June, the Centers for Disease Control issued a bulletin of nine brief paragraphs. Five gay men in Los Angeles were dying with a strange cluster of symptoms.821 [990] From humble beginnings, AIDS has killed millions.822 [991] The relaxation of sexual mores, blood banking, and injection drug use aided the spread of the AIDS virus, but where did this virus come from? The leading theory is R20;direct exposure to animal blood and secretions as a result of hunting, butchering, or other activities (such as consumption of uncooked contaminated meat)R30;.R21;823 [992] Experts believe the most likely scenario is that HIV arose from humans sawing their way into the forests of west equatorial Africa on logging expeditions, butchering chimpanzees for their flesh along the way.824 [993] In Botswana, 39% of the countryR17;s adults are infected with HIV. There are countries in which 15% or more of the nationR17;s children have been orphaned by AIDS killing both parents. Five people die from AIDS every minute. By 2010, we expect 45 million newly infected people to follow down the same nightmarish path.825 [994] Although there has been progress in the treatment of AIDS, attempts at a vaccine or cure have been undermined by the uncontrollable mutation rate of HIV. Someone butchered a chimp a few decades ago and now 20 million people are dead.826 [995] The bushmeat industry may already be cooking up a new AIDS-like epidemic. Samples of blood were taken from rural villagers in Cameroon, known for their frequent exposure to wild primate body fluids from hunting. Ten were found to be infected with foreign ape viruses.827 [996] R20;Our study is the first to demonstrate that these retroviruses are actively crossing into people,R21; the chief investigator said.828 [997] Their article published in Lancet ends, R20;Our results show simian retroviral zoonosis in people who have direct contact with fresh non-human primate bushmeat, and suggest that such zoonoses are more frequent, widespread, and contemporary than previously appreciated.R21;829 [998] In the accompanying Lancet editorial, we are reminded that zoonotic cross-species infections are R20;among the most important public health threats facing humanity.R21;830 [999] While zoonotic diseases like rabies kill about 50,000 people globally a year,831 [1000] humans generally end up as the dead-end host for the virus. In terms of global public health implications, the greatest fear surrounds viruses that can not only jump from animals to humans, but then spread person to person. Only a few people eat chimpanzees, but many people in the world have sex. (c) BirdFluBook.com | Home [1001] | Website by Lantern Media [1002] Bird Flu - Aggressive Symbiosis BirdFluBook.com [1003] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1004] Aggressive Symbiosis Richard Preston wrote in The Hot Zone: R20;In a sense, the earth is mounting an immune response against the human species.R21;832 [1005] His fanciful R20;revenge of the rainforestR21; theme makes for good reading but lacks a grounding in science. There is an emerging evolutionary theory, however, that may help provide a biological basis for the lethality of emerging infectious disease. Viruses have long been thought of as the ultimate parasite, R20;feedingR21; off the host organism while contributing nothing of value in return. This view may be changing. Frank Ryan, a British physician-researcher, has introduced the concept of R20;aggressive symbiosis.R21; As opposed to parasitism, where one organism exclusively exploits the other, symbiotic relationships in biology can be characterized by both species benefiting in some way. Symbiosis is Greek for R20;companionship,R21; whereas parasite is from the Greek parasitos, meaning R20;person who eats at someone elseR17;s table.R21;833 [1006] The classic symbiotic relationship is of the sea anemone and the clown fish. The clown fish is afforded protection among the stinging tentacles of the anemone. This is mutually beneficial for the sea anemone, which refrains from stinging the clown fish in return for help luring other prey into its grasp. Not all symbiotic relationships are as tender, though. In Borneo, a species of rattan cane has developed a symbiotic relationship with a species of ants. The ants construct a nest around the cane and drink at its sugary sap. When an herbivore approaches to nibble its sweet leaves, the ants rush out and attack to defend their sugar daddy.834 [1007] Ryan draws an analogy between this kind of behaviorR12;which he terms aggressive symbiosisR12;and that of new zoonotic agents of disease. He argues that when it comes to emerging animal viruses, animals are the cane and ants are the virus. For example, a herpes virus, Herpesvirus saimiri, has seemingly developed a symbiosis with the squirrel monkey, passing harmlessly from mother to baby. If a rival species like a marmoset monkey invades their territory, the virus jumps species and wipes out the challenger, inducing fulminant cancers in the invaders. In this way, the virus protects the squirrel monkeysR17; habitat from invading primates. It is in the squirrel monkeysR17; evolutionary best interest not to try to purge the virus from their systems, and so the virus is able to replicate free of immune interference. Another similar virus, Herpesvirus ateles, protects spider monkeys in South American jungles in much the same way, killing virtually 100% of encroaching monkeys lacking immunity. The spider monkeys pass both the virus and immunity to the virus from mother to child, benefiting all. This R20;jungle immune systemR21; protects the inhabitants from invading primate species, even when that invading species is us.835 [1008] This may explain why Ebola is so virulentR12;in fact too virulent. The disease evoked by the Ebola virus is so fierce that victims donR17;t make it very far to infect others, which would seem to make the virus an evolutionary failure. Under the aggressive symbiosis hypothesis, however, the virus may be fulfilling its evolutionary purpose after all, protecting a host species we simply havenR17;t identified.836 [1009] Interestingly, it works both ways. The herpes virus that causes nothing more serious in humans than cold sores at the corner of oneR17;s mouth can pose a risk of lethal infection to monkeys in Central and South America.837 [1010] Simian (from the Latin simia for R20;apeR21;838 [1011] ) Immunodeficiency Virus is considered the precursor to the human AIDS virus, HIV.839 [1012] Chimpanzees have SIV, but never get AIDS.840 [1013] SIV is harmless in the African green monkey, but can cause acute disease in the yellow baboon.841 [1014] Aggressive symbiosis is an argument for keeping viruses confined to their natural niches. (c) BirdFluBook.com | Home [1015] | Website by Lantern Media [1016] Bird Flu - Wild Tastes BirdFluBook.com [1017] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1018] Wild Tastes Guangdong wet market selling civet cats In central Africa, consumers eat an estimated 579 million wild animals every year, totaling billions of pounds of meat. But the trade in bushmeat is not limited to Africa. In the Amazon basin, another few hundred million pounds of wild animal meat may be consumed, including between 6 and 16 million individual mammals. R20;All considered,R21; wrote two chief wildlife veterinarians in the Council on Foreign Relations journal Foreign Affairs, R20;at least a billion direct and indirect contacts among wildlife, humans, and domestic animals result from the handling of wildlife and the wildlife trade annually.R21;842 [1019] The intensive commercial bushmeat trade started in the live animal markets of Asia,843 [1020] particularly in Guangdong, the southern province surrounding Hong Kong from which H5N1 arose.844 [1021] Literature from the Southern Song Dynasty (1127R11;1279) describes the residents of Guangdong eating R20;whatever food, be it birds, animals, worms, or snakes.R21;845 [1022] Today, live animal so-called R20;wetR21; markets cater to the unique tastes of the people of Guangdong, where shoppers can savor R20;Dragon-Tiger-Phoenix Soup,R21; a brew made up of snakes, cats, and chickens,846 [1023] or delicacies like san jiao, R20;three screams.R21; The wriggling baby rat is said to scream first when hefted with chopsticks, a second time as it is dipped into vinegar, and a third time as it is bitten.847 [1024] In China, animals are eaten for enjoyment, sustenance, and for their purported medicinal qualities. There are reports of dogs being R20;savagely beaten before death to increase their aphrodisiac properties.R21;848 [1025] Cats are killed and boiled down into R20;cat juice,R21; used to treat arthritis. Many of the cats are captured ferals in ill health, so R20;consuming such diseased cats is a time bomb waiting to explode,R21; claimed the chief veterinarian of the Australian RSPCA. The cat-like masked palm civet has been a popular commodity in Chinese animal markets.849 [1026] In addition to being raised for their flesh, civet cat penis is soaked in rice wine for use as an aphrodisiac.850 [1027] These animals also produce the most expensive coffee in the world.851 [1028] So-called R20;foxdung coffeeR21; is produced by feeding coffee beans to captive civets and then recovering the partially digested beans from the feces.852 [1029] A musk-like substance of buttery consistency secreted by the anal glands gives the coffee its characteristic flavor and smell.853 [1030] One might say this unique drink is good to the last dropping. The masked palm civet has been blamed for the SARS epidemic.854 [1031] R20;A culinary choice in south China,R21; one commentator summed up in Lancet, R20;led to a fatal infection in Hong Kong, and subsequently to 8,000 cases of severe acute respiratory syndrome (SARS), and nearly 1,000 deaths in 30 countries on six continents.R21;855 [1032] Ironically, one reason civets are eaten is for protection from respiratory infections.856 [1033] As noted in the China Daily, R20;We kill them. We eat them. And, then, we blame them.R21;857 [1034] Wildlife have been hunted for 100,000 years.858 [1035] R12; Why the payback now? Growing populations and increasing demands for wildlife meat exceed local supplies of these animals.859 [1036] This has resulted in an enormous (and largely illegal) transboundary trade of wildlife and the setting up of intensive captive production farms in which wild animals are raised under poor sanitation in unnatural stocking densities. These animals are then packed together into markets for sale. All of these factors favor the spread and emergence of mutant strains of pathogens capable of infecting hunters, farmers, and shoppers.860 [1037] Live markets have been described by the director of the Wildlife Conservation Society as veritable human and animal R20;disease factories.R21;861 [1038] Following the SARS outbreak, the Chinese government reportedly confiscated more than 800,000 wild animals from the markets of Guangdong. Animals sold live guarantee freshness in the minds of consumers, but in all their R20;freshness,R21; the animals cough and defecate over one another, spewing potential pathogens throughout the market wet with blood and urine.862 [1039] These viral swap meets are blamed for the transformation of a class of viruses, previously known for causing the common cold, into a killer.863 [1040] (c) BirdFluBook.com | Home [1041] | Website by Lantern Media [1042] Bird Flu - Shipping Fever BirdFluBook.com [1043] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1044] Shipping Fever The bushmeat trade is not the virusesR17; only ticket around the world. More than 50 million live farm animalsR12;cattle, sheep, and pigsR12;are traded across state lines in the United States alone every year, along with untold numbers of live birds on their way to slaughter.864 [1045] A pound of meat can travel a thousand miles R20;on the hoofR21; in the United States before reaching dinner tables.865 [1046] Live farm animal long-distance transport not only spreads disease geographically, but can make animals both more infectious and more vulnerable to infection. According to the UNR17;s Food and Agriculture Organization, R20;Transport of livestock is undoubtedly the most stressful and injurious stage in the chain of operations between farm and slaughterhouse,R21; leading to significant R20;loss of production.R21;866 [1047] This stress impairs immune function, increasing the animalsR17; susceptibility to any diseases they might experience on their prolonged, often overcrowded journeys.867 [1048] Some pathogens that would not lead to disease under normal conditions, for example, become activated during transport due to stress-induced immunosuppression, triggering a wide variety of diarrheal and respiratory diseases. So-called R20;shipping fever,R21; the bovine version of which costs U.S. producers more than $500 million a year, is often caused by latent pathogensR12;including a SARS-like virus868 [1049] R12;which may become active when shipping live cattle long distances.869 [1050] Given the increased disease risk, the European CommissionR17;s Scientific Committee on Animal Health and Animal Welfare recommends that R20;[j]ourneys should be as short as possible.R21;870 [1051] Once an animal is infected, the stress of transport can lead to increased shedding of the pathogen.871 [1052] In one study at Texas Tech University, for example, the average prevalence of Salmonella within feces and on the hides of cattle was 18% and 6%, respectively, before transport. But cram animals onto a vehicle and truck them just 30 to 40 minutes, and the levels of Salmonella found in feces jumped from 18% to 46%; the number of animals covered with Salmonella jumped from 6% to 89% upon arrival at the slaughterplant, where fecal contamination on the hide or within the intestines can end up in the meat.872 [1053] Similar results were found in pigs.873 [1054] The physiological stress of transport thus increases a healthy animalR17;s susceptibility to disease,874 [1055] while at the same time enhancing a sick animalR17;s ability to spread contagion.875 [1056] No surprise, then, that the FAO blames R20;[t]ransport of animals over long distances as one cause of the growing threat of livestock epidemicsR30;.R21;876 [1057] Dozens of outbreaks of foot and mouth disease, for example, have been tied to livestock movements877 [1058] or contaminated transport vehicles.878 [1059] The FAO describes live animal transport as R20;ideally suited for spreading diseaseR21; given that animals may originate from different herds or flocks and are R20;confined together for long periods in a poorly ventilated stressful environment.R21;879 [1060] Given the associated R20;serious animal and public health problems,R21; the Federation of Veterinarians of Europe have called for the replacement of the long-distance transportation of animals for slaughter as much as possible to a R20;carcass-only trade.R21;880 [1061] (c) BirdFluBook.com | Home [1062] | Website by Lantern Media [1063] Bird Flu - AmericaR17;s Soft Underbelly BirdFluBook.com [1064] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1065] AmericaR17;s Soft Underbelly According to the Government Accountability Office, the watchdog arm of Congress , long-distance live animal transport not only places countries at risk for catastrophic disease outbreaks,881 [1066] but it makes them vulnerable to bioterrorism as well.882 [1067] U.S. animal agriculture has been described as a particularly easy target,883 [1068] as R20;one of the probable threats for an economic attack on this country,R21;884 [1069] according to the U.S. Deputy Secretary of Agriculture, and also as a direct attack on our citizenry. In 2004, the RAND Corporation prepared a report on agroterrorism for the Office of the Secretary of Defense titled, Hitting AmericaR17;s Soft Underbelly. It blamed AmericaR17;s vulnerability in part on the R20;concentrated and intensive nature of contemporary U.S. farming practices.R21;885 [1070] According to the last USDA census in 1997, just 2% of the nationR17;s feedlots produced three-quarters of the cattle and 1% of U.S. egg farms confine more than three-fourths of the nationR17;s egg-laying hens.886 [1071] Given that R20;highly crowdedR21; animals are reared in R20;extreme proximityR21; in the United States, one infected animal could quickly expose thousands of others.887 [1072] The RAND Corporation points out that individual animals raised by U.S. agriculture have become progressively more prone to disease as a result of increasingly routine invasive procedures: Herds that have been subjected to such modificationsR12;which have included everything from sterilization programs to dehorning, branding, and hormone injectionsR12;have typically suffered higher stress levels that have lowered the animalsR17; natural tolerance to disease from contagious organisms and increased the viral and bacterial R20;volumesR21; that they normally shed in the event of an infection.888 [1073] Long-distance live transport could then ferry the spreading infection, according to USDA models, to as many as 25 states within five days.889 [1074] Curtailing the long-distance live transport of animals, as well as the concentration and intensification of the food animal industry, could thus potentially be a matter of national security. (c) BirdFluBook.com | Home [1075] | Website by Lantern Media [1076] Bird Flu - Pet Peeves BirdFluBook.com [1077] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1078] Pet Peeves Monkeypox in Wisconsin R20;ItR17;s corny and itR17;s a cliché,R21; said one veterinary virologist, R20;but Mother Nature is the worldR17;s worst bioterrorist.R21;890 [1079] Her viruses can escape the rainforests in animals living or dead, as pets or as meat. The international trade in exotic pets is a multibillion-dollar industry, and exotic pets can harbor exotic germs.891 [1080] Wildlife traffickingR12;the illegal trade in wildlife and wildlife partsR12;is, in the United States alone, a soaring black market worth $10 billion a year.892 [1081] Before, the only wings viruses could typically find on which to travel were those of the mosquito. Now they have jumbo jets. The U.S. imports an unbelievable 350,000 different species of live animals. The deputy director of the U.S. Fish and Wildlife Service testified before a Senate committee in 2003 that the United States imports more than 200 million fish, 49 million amphibians, 2 million reptiles, 365,000 birds, and 38,000 mammals in a single year. With fewer than 100 U.S. inspectors monitoring traffic nationwide, even if they worked 24/7, this would allow but seconds to inspect each incoming animal.893 [1082] Whether for exotic pets or exotic cuisine, imported animals transported together under cramped conditions end up in holding areas in dealer warehouses, where they and their viruses can mingle further.894 [1083] The 2003 monkeypox outbreak across a half-dozen states in the Midwest was traced to monkeypox-infected Gambian giant rats shipped to a Texas animal distributor along with 800 other small mammals snared from the African rainforest. The rodents were co-housed with prairie dogs who contracted the disease and made their way into pet stores and swap meets via an Illinois distributor. One week the virus is in a rodent in the dense jungles of Ghana, along the Gold Coast of West Africa; a few weeks later that same virus finds itself in a three-year-old Wisconsin girl whose mom bought her a prairie dog at a 4-H swap meet. R20;Basically you factored out an ocean and half a continent by moving these animals around and ultimately juxtaposing them in a warehouse or a garage somewhere,R21; said WisconsinR17;s chief epidemiologist.895 [1084] Nobody ended up getting infected directly from the African rodents; they caught the monkeypox from secondary and tertiary contacts inherent to the trade.896 [1085] The international pet trade in exotics has been described as a R20;major chink in the USA public health armor.R21;897 [1086] As one expert quipped, R20;It was probably easier for a Gambian rat to get into the United States than a Gambian.R21;898 [1087] Previously, monkeypox was typically known only to infect bushmeat hunters living in certain areas of Africa who ate a specific species of monkey.899 [1088] R20;Nothing happens on this planet that doesnR17;t impact us,R21; notes the chair of medicine at the Medical College of Wisconsin. R20;WeR17;re wearing clothes that were made in China. WeR17;re eating foods that were grown in Chile,R21; he said. R20;Could there be a more poignant example than this [monkeypox outbreak] happening in Wisconsin? People in Wisconsin donR17;t even know where Gambia is.R21;900 [1089] Monkeypox is caused by a virus closely related to human smallpox, but currently with only a fraction of the lethality.901 [1090] Human-to-human transmission has been known to occur, however, and there is concern that monkeypox could evolve into a more R20;successful human pathogen.R21;902 [1091] The CDC editorialized that the U.S. monkeypox outbreak R20;highlights the public health threat posed by importation, for commercial purposes, of exotic pets into the United States.R21;903 [1092] R20;As long as humans are going to associate in a close way with exotic animals,R21; said the dean of the University of Texas Medical Branch in Galveston, R20;theyR17;re going to be at risk.R21;904 [1093] (c) BirdFluBook.com | Home [1094] | Website by Lantern Media [1095] Bird Flu - Pigs Barking Blood BirdFluBook.com [1096] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1097] Pigs Barking Blood As H5N1 was emerging in Hong Kong in 1997 more than ten million acres of virgin forest were burning in Borneo and Sumatra. The resulting haze is thought to have caused a mass migration of fruit bats searching for food. Forced out of the forests and into areas of human cultivation, some of these so-called flying foxes nested in mango trees overlying huge Malaysian pig farms. The flying foxes dribbled urine and half-eaten fruit slobbered with saliva into the pig pens.905 [1098] The bat urine and saliva were both later found to contain a virus906 [1099] R12;named the Nipah virus, after the village with the first human fatality. That virus was harmless to the fruit bats, but far from harmless to everyone else.907 [1100] The pigs developed an explosive cough that became known as the R20;one-mile cough,R21; because the violent hacking could be heard from far away. The disease was called R20;barking pig syndrome,R21; after the unusual, loud barking cough.908 [1101] Pigs started coughing blood909 [1102] and developing neurological symptoms. Sows pressed their heads against the walls, started twitching, became paralyzed, or seized into spasms. Many died within 24 hours.910 [1103] Using pigs as its conduit, the virus turned its attention to others. Almost every animal in the vicinity started falling illR12;other farm animals like goats and sheep, companion animals like dogs, cats, and horses, and wild animals like deer fell into fatal respiratory distress.911 [1104] Human animals were no exception. People broke out in high fevers and headaches as their brains began to swell. Many started to convulse. Those who went into a coma never woke up.912 [1105] On autopsy, their brains and lungs were swollen with fluid.913 [1106] The disease erupted in the northern part of the Malaysian peninsula, but ultimately swept nationwide on a seven-month rampage thanks to long-distance animal transport.914 [1107] R20;A hundred years ago, the Nipah virus would have simply emerged and died out,R21; the Thai Minister of Public Health explained; R20;instead it was transmitted to pigs and amplified. With modern agriculture, the pigs are transported long distances to slaughter. And the virus goes with them.R21;915 [1108] A one-mile cough is still only a one-mile cough in a country that is almost 5,000 miles around.916 [1109] The Nipah virus was finally stamped out by stamping out much of the Malaysian pig population.917 [1110] Pig farmers started the cull, beating the animals to death with batons, but the Malaysian army needed to come in to finish the job, killing more than one million pigs.918 [1111] The virus turned out to be one of the deadliest of human pathogens, killing 40% of those infected, a toll that propelled it onto the U.S. list of potential bioterrorism agents.919 [1112] Nipah is also noted for its R20;intriguing abilityR21; to cause relapsing brain infections in some survivors920 [1113] many months after initial exposure.921 [1114] Even more concerning, a 2004 resurgence of Nipah virus in Bangladesh showed a case fatality rate on par with EbolaR12;75%R12;and showed evidence of human-to-human transmission.922 [1115] The surfacing of the Nipah virus demonstrates how slash-and-burn deforestation may contribute to disease emergence in unexpected ways. Remote rainforest intrusions can bring humans into contact with viruses they had never before been in contact with, or, as in the case of Nipah, it can bring the new viruses out to us. One zoologist quipped R20;Nipah appears to be a case of the bats getting some payback.R21;923 [1116] This may not have been possible without collusion from the pig industry. It is likely no coincidence that the Nipah outbreak began on one of the largest pig farms in the country.924 [1117] Raising pigs is not new in Malaysia, but intensive industrial production is. The Leong Seng Nam farm, where the epidemic broke out, confined more than 30,000 pigs. The Nipah virus, like all contagious respiratory diseases, is a density-dependent pathogen,925 [1118] requiring a certain threshold density of susceptible individuals to spread, persist, and erupt from within a population.926 [1119] Scientists suspect it may have taken more than a year of circulating in this unnaturally massive herd before it learned to fully adapt and mutate into a strain that explodes into other mammals.927 [1120] R20;Without these large, intensively managed pig farms in Malaysia,R21; the director of the Consortium for Conservation Medicine said, R20;it would have been extremely difficult for the virus to emerge.R21;928 [1121] China is the worldR17;s largest producer of pork.929 [1122] Much of the pig production is concentrated in the Sichuan province, which in 2005 suffered an unprecedented outbreak in scope and lethality of Streptococcus suis, a newly emerging zoonotic pig pathogen.930 [1123] Strep. suis is a common cause of meningitis in intensively farmed pigs worldwide931 [1124] and presents most often as meningitis in people as well,932 [1125] particularly those who butcher infected pigs or later handle infected pork products.933 [1126] Due to involvement of the auditory nerves connecting the inner ears to the brain, half of the human survivors become deaf.934 [1127] The World Health Organization reported that it had never seen so virulent a strain935 [1128] and blamed intensive confinement conditions as a predisposing factor in its sudden emergence, given the stress-induced suppression of the pigsR17; immune systems.936 [1129] The USDA explains that this bacteria can exist as a harmless component of a pigR17;s normal bacterial flora, but stress due to factors like crowding and poor ventilation can drop the animalR17;s defenses long enough for the bacteria to become invasive and cause disease.937 [1130] ChinaR17;s Assistant Minister of Commerce admitted that the disease was R20;found to have direct links with the foul environment for raising pigs.R21;938 [1131] The disease can spread through respiratory droplets or directly via contact with contaminated blood on improperly sterilized castration scalpels, tooth-cutting pliers, or tail-docking knives.939 [1132] China boasts an estimated 14,000 confined animal feeding operations (CAFOs),940 [1133] colloquially known as factory farms, which have stocking densities conducive to the emergence and spread of disease.941 [1134] The United States is the worldR17;s second-largest pork producer,942 [1135] and Strep. suis infection is also an emerging pathogen in North American pig production, especially in intensive confinement settings.943 [1136] According to the Journal of Swine Health and Production, human cases of meningitis in North America are likely underdiagnosed and mis-identified944 [1137] due to the lack of adequate surveillance.945 [1138] The WHO encourages careful pork preparation,946 [1139] and North American agriculture officials urge Strep. suis disease awareness for people R20;who work in pig barns, processing plants, as well as in the home kitchenR30;.R21;947 [1140] The first human case of Strep. suis was not in Asia or in the United States, however, but in Europe. The Dutch pig belt, extending into parts of neighboring Belgium and Germany, has the densest population of pigs in the world, more than 20,000 per square mile. This region has been hit with major epidemics within recent years of hog cholera and foot and mouth disease, leading to the destruction of millions of animals. R20;With more and more pigs being raised intensively to satisfy EuropeR17;s lust for cheap pork, epidemics are inevitable,R21; wrote New ScientistR17;s Europe Correspondent. R20;And the hogs may not be the only ones to get sick.R21;948 [1141] Even industry groups like the American Association of Swine Veterinarians blame R20;[e]merging livestock production systems, particularly where they involve increased intensificationR21; as a main reason why zoonotic diseases are of increasing concern. These intensive systems, in addition to their high population density, R20;may also generate pathogen build-ups or impair the capacity of animals to withstand infectious agents.R21;949 [1142] Increasing consumer demand for animal products worldwide over the past few decades has led to a global explosion in massive animal agriculture operations which have come to play a key role in the Third Age of emerging human disease.950 [1143] (c) BirdFluBook.com | Home [1144] | Website by Lantern Media [1145] Bird Flu - Breeding Grounds BirdFluBook.com [1146] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1147] Breeding Grounds Per capita meat consumption in China (FAO) In response to the torrent of emerging and re-emerging zoonotic diseases jumping from animals to people, the worldR17;s three leading authoritiesR12;the Food and Agriculture Organization of the United Nations, the World Health Organization, and the World Organization for Animal Health (OIE)R12;held a joint consultation in 2004 to determine the key underlying causes. Four main risk factors for the emergence and spread of these new diseases were identified. Bulleted first: R20;Increasing demand for animal protein.R21;951 [1148] This has led to what the Centers for Disease Control refer to as R20;the intensification of food-animal production,R21; the factor blamed in part for the increasing threat.952 [1149] Animals were domesticated 10,000 years ago, but never like this. Chickens used to run around the barnyard on small farms. Now, R20;broilerR21; chickensR12;those raised for meatR12;are typically warehoused in long sheds confining an average of 20,000 to 25,000 birds.953 [1150] A single corporation, Tyson, churns out more than 20 million pounds of chicken meat a day.954 [1151] Worldwide, an estimated 70% to 80% of egg-laying chickens are intensively confined in battery cages,955 [1152] small barren wire enclosures stacked several tiers high and extending down long rows in windowless sheds.956 [1153] It is not uncommon for egg producers to keep hundreds of thousandsR12;or even a millionR12;hens confined on a single farm.957 [1154] Half the worldR17;s pig populationR12;now approaching 1 billionR12;is also crowded into industrial confinement operations.958 [1155] This represents the most profound alteration of the animal-human relationship in 10,000 years.959 [1156] Driven by the population explosion, urbanization, and increasing incomes,961 [1157] the per-capita consumption of meat, eggs, and dairy products has skyrocketed in the developing world,962 [1158] leading to a veritable Livestock Revolution beginning in the 1970s, akin to the 1960s Green Revolution in cereal grain production.963 [1159] World meat production has risen more than 500% over the past few decades.964 [1160] To meet the growing demand, livestock production will have to double by 2020.965 [1161] To evaluate the global risks of infectious animal diseases, the Iowa-based, industry-funded966 [1162] Council for Agricultural Science and Technology created a task force that included public health experts from the WHO, veterinary experts from the OIE, agriculture experts from the USDA, and industry experts from the likes of the National Pork Board. Its report was released in 2005 and traced the history of livestock production from family-based farms to industrial confinement. Traditional systems are being replaced by intensive systems at a rate of more than 4% a year, particularly in Asia, Africa, and South America. R20;A major impact of modern intensive production systems,R21; the report reads, R20;is that they allow the rapid selection and amplification of pathogens that arise from a virulent ancestor (frequently by subtle mutation), thus there is increasing risk for disease entrance and/or dissemination.R21; Modern animal agriculture provides R20;significant efficiency in terms of economy of scale,R21; but the R20;cost of increased efficiencyR21; is increased disease risk. R20;Stated simply,R21; the report concluded, R20;because of the Livestock Revolution, global risks of disease are increasing.R21;967 [1163] In the United States, the average numbers of animals on chicken, pig, and cattle operations approximately doubled between 1978 and 1992.968 [1164] This increasing population density seems to be playing a key role in triggering emerging epidemics. In terms of disease control, according to the FAO, R20;[t]he critical issue is the keeping [of] more and more animals in smaller and smaller spacesR30;.R21;969 [1165] The unnaturally high concentration of animals confined indoors in a limited airspace producing enormous quantities of manure provides, from a microbiologistR17;s perspective, R20;ideal conditions for infectious diseases.R21;970 [1166] (c) BirdFluBook.com | Home [1167] | Website by Lantern Media [1168] Bird Flu - Back to the Dark Ages BirdFluBook.com [1169] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1170] Back to the Dark Ages Before the Sanitary Revolution of the 19th century established sewage collection and treatment, cities were centers of filth and pestilence. R20;Thousands of tons of midden filth filled the receptacles, scores of tons lay strewn about where the receptacles would receive no more,R21; observed an English medical officer in Leeds in 1866. R20;Hundreds of people, long unable to use the privy because of the rising heap, were depositing on the floors.R21;971 [1171] Fecal diseases from squalor and overcrowding, like cholera and typhoid fever, were rampant. Animals are increasingly raised for food today in conditions straight out of the Middle Ages.972 [1172] Award-winning science journalist and author Madeline Drexler compares modern meat production facilities to a R20;walled medieval city, where waste is tossed out the window, sewage runs down the street, and feed and drinking water are routinely contaminated by fecal material.R21;973 [1173] In the United States, farm animals produce more than one billion tons of manure each yearR12;the weight of 10,000 Nimitz-class aircraft carriers.974 [1174] That is one huge load of crap. Each steer can produce 75 pounds of manure a day, turning feedlots into wading pools of waste.975 [1175] R20;Animals are living in medieval conditions and weR17;re living in the 21st century,R21; the chief of the CDCR17;s Foodborne and Diarrheal Diseases Branch pointed out. R20;Consumers have to be aware that even though they bought their food from a lovely modern deli bar or salad bar, it started out in the 1600s.R21;976 [1176] Robert F. Kennedy, Jr., describing hog farms: Stadium-size warehouses shoehorn 100,000 sows into claustrophobic cages that hold them in one position for a lifetime over metal-grate floors. Below, aluminum culverts collect and channel their putrefying waste into 10-acre, open-air pits three stories deep from which miasmal vapors choke surrounding communities and tens of millions of gallons of hog feces ooze into North CarolinaR17;s rivers.977 [1177] The slum conditions on factory farms are breeding grounds for disease.978 [1178] The British Agriculture Ministry walks us through the microbiological hazards of modern pig production: Treatment may be given to sows for metritis, mastitis, and for diseases such as erysipelas and leptospirosis. In most indoor herds antibiotic treatment starts soon after birth. Piglets will receive drugs for enteritis and for respiratory disease. From weaning (usually three weeks) all piglets are gathered, mixed and then reared to finishing weights. Weaners usually develop post-weaning diarrhea caused by E. coli which occurs on day 3 post-weaningR30;. Post-weaning diarrhea is quickly followed by a range of other diseases. GlasserR17;s Disease (haemophilus parasuis) occurs at 4 weeks, pleuropneumonia at 6R11;8 weeks, proliferative enteropathy from 6 weeks and spirochaetal diarrhea and colitis at any time from 6 weeks onwardR30;. At 8 weeks the pigs are termed growers and moved to another house. Here they will develop enzootic pneumonia, streptococcal meningitis (Streptococcus suis), and, possibly, swine dysentery. Respiratory disease may cause problems until slaughter.979 [1179] According to animal scientists at Purdue and the University of Georgia, the late 19th and early 20th centuries ironically R20;might well have been the golden age for domesticated livestock in terms of welfare and disease control.R21;980 [1180] High-density production allows for disease to spread faster to greater numbers of animals.981 [1181] Because intensive operations are vulnerable to catastrophic losses from disease,982 [1182] the USDA considers animal disease R20;the single greatest hindrance to efficient livestock and poultry production on a global basis.R21;983 [1183] Industrial animal factories lead not only to more animal-to-animal contact, but to more animal-to-human contact, particularly when production facilities border urban areas.984 [1184] Due to land constraints around the world, massive livestock operations are moving closer to major urban areas in countries like Bangladesh. This is bringing together the worst of both worlds985 [1185] R12;the congested inner cities of the developing world, combined with the congested environment on industrial farms.986 [1186] The United NationR17;s FAO considers this a dangerous nexus, providing R20;flash pointsR21; for the source of new diseases.987 [1187] There are other systemic factors that inherently increase the susceptibility of these animals to disease. The USDA cites a loss of genetic diversity in herds and flocks.988 [1188] A former chief of the Special Pathogens Branch of the CDC explains: R20;Intensive agricultural methods often mean that a single, genetically homogeneous species is raised in a limited area, creating a perfect target for emerging diseases, which proliferate happily among a large number of like animals in close proximity.R21;989 [1189] The stress associated with the routine mutilations farm animals are subjected to without anesthesia990 [1190] R12;including castration, branding, dehorning, detoeing, teeth clipping, beak trimming, and tail docking991 [1191] R12;coupled with the metabolic demands of intensive production, such as artificially augmented reproduction, lactation, early weaning, and accelerated growth rates, leave animals, according to one review, R20;extremely prone to disease.R21;992 [1192] Never before have microbes had it so good. In the 20 years between 1975 (around the time when the dean of YaleR17;s School of Medicine famously told students that there were R20;no new diseases to be discoveredR21;993 [1193] ) and 1995, 17 foodborne pathogens emerged, almost one every year.994 [1194] With billions of feathered and curly-tailed test-tubes for viruses to incubate and mutate within, a WHO official described the last few decades as R20;the most ambitious short-term experiment in evolution in the history of the world.R21;995 [1195] (c) BirdFluBook.com | Home [1196] | Website by Lantern Media [1197] Bird Flu - Stomaching Emerging Disease BirdFluBook.com [1198] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1199] Stomaching Emerging Disease Five tons of animal manure is produced in the United States every year for every man, woman, and child in the country,996 [1200] and some of it ends up in the food and water supply. Excess manure nitrates can cause a condition called methemoglobinemia, or R20;blue-baby syndrome,R21; a rare but under-recognized cause of illness and death among U.S. infants, as well as asphyxiating aquatic ecosystems with algae blooms.997 [1201] In the 1990s, this ecological problem bloomed into a public health issue as well with the emergence of the carnivorous algae Pfiesteria piscicida (Latin for R20;fish killerR21;).998 [1202] Likened to grass feeding on sheep, this tiny plankton releases a toxin that skins fish alive to feed on their flesh. More than one billion fish have been killed,999 [1203] and fish are not the only ones affected. Fishermen, recreational boaters, and swimmers along the eastern seaboard of the United States started developing skin lesions and neurological deficits, such as memory loss, disorientation, and speech impediments. One Pfiesteria researcher was sent to the hospital1000 [1204] and was still experiencing neurological symptoms years later.1001 [1205] Experts blame poultry manure runoff for the emergence of this R20;cell from hell,R21;1002 [1206] leading to tighter poultry industry regulation.1003 [1207] In our kitchens, animal excrement leads to food poisoning. The risks associated with this R20;plate wasteR21; have intensified along with the industry that created it. In its landmark 1992 report, Emerging Infections: Microbial Threats to Health in the United States, the National Academy of SciencesR17; Institute of Medicine states that R20;the introduction of feedlots and large-scale poultry rearing and processing facilities has been implicated in the increasing incidence of human pathogens, such as Salmonella, in domestic animals over the past 30 years.R21;1004 [1208] As microbiologist John Avens told a poultry meeting, R20;Salmonella infection of animals will occur more frequently and affect more individual animals as concentration of confinement increases.R21;1005 [1209] The World Health Organization estimates the number of people killed worldwide from foodborne microbial diseases in the millions, with animal products topping the list of causes.1006 [1210] The WHO attributes the global rise in foodborne illness not only to the R20;greater consumption of foods of animal origin,R21; but the R20;methods of intensive productionR21; required to supply such a demand.1007 [1211] About half of all known foodborne pathogens have been discovered within just the past 25 years.1008 [1212] In industrialized countries, the incidence of reported infectious food- and waterborne illnesses has more than doubled since the 1970s.1009 [1213] According to the best estimate of the CDC, an astonishing 76 million Americans come down with foodborne illness annually. ThatR17;s nearly one in four every single year. Remember that R20;24-hour fluR21; you or a family member may have had last year? ThereR17;s no such thing as a 24-hour flu. It may very well have been food poisoning.1010 [1214] In todayR17;s food safety lottery, each year Americans have approximately a 1 in 1,000 chance of being hospitalized, and about a 1 in 50,000 chance of dying, simply from eating.1011 [1215] It may be from E. coli O157:H7 in hamburgers, Salmonella in eggs, Listeria in hot dogs, R20;flesh-eatingR21; bacteria in oysters,1012 [1216] or Campylobacter in Thanksgiving turkeys. According to the executive editor of Meat Processing magazine, R20;Nearly every food consumers buy in supermarkets and order in restaurants can be eaten with certainty for its safetyR12;except for meat and poultry products.R21;1013 [1217] The latest comprehensive analysis of sources for foodborne illness outbreaks found that chickens were the premiere cause overall. In fact, poultry and eggs caused more cases than red meat, seafood, and dairy products combined.1014 [1218] This British analysis showed that fruits and vegetables carried the lowest disease and hospitalization risk, whereas poultry carried the highest. The researchers conclude, R20;Reducing the impact of indigenous foodborne disease is mainly dependent on controlling the contamination of chicken.R21;1015 [1219] Good luck. In the United States, the overwhelming majority of the 9 billion chickens raised each year are stocked in densities between 10 and 20 birds per square yard,1016 [1220] ,1017 [1221] unable even to stretch their wings.1018 [1222] Under this avian carpet is a fecal carpet of filth most of the birds spend their lives upon.1019 [1223] Chicken of the Sea(R) is an ironic brand name for canned tuna. The only food animal industry with greater stocking density than poultry production is fish farming, where tanks routinely squeeze up to a ton of animals into a dozen cubic yards of water (9m3).1020 [1224] Floating cages have been known to hold up to four times more.1021 [1225] The water can become so saturated with feed and feces that these fish-in-a-barrel operations may be more aptly dubbed fish-in-a-toilet. As the chief of the CDCR17;s Special Pathogens Branch has pointed out, whether in a human megacity, a broiler chicken shed, or an aquaculture tank, any time one crowds a monoculture of single species together, one is asking for trouble.1022 [1226] Combined with the stress associated with overcrowding and poor water quality, it is not hard to imagine how the factory farming methods associated with the so-called R20;Blue RevolutionR21; expansion of fish farming in the 1980s1023 [1227] resulted in the emergence of another zoonotic disease.1024 [1228] Discovered first in an Amazon dolphin in the 1970s from which it got its name, Streptococcus iniae (inia is the Guarayo Indian word for R20;dolphinR21;1025 [1229] ) started wiping out fish stocks on intensive fish farms around the world with epidemics of acute meningitis.1026 [1230] By the 1990s, the dolphin wasnR17;t the only mammal discovered to be infected. In 1995, the first confirmed spread to humans who handled fish in their kitchens was published in the New England Journal of Medicine. Most of the human reports involved just skin infections, but in a few cases, the bacteria became invasive, spread through victimsR17; bloodstreams, seeding infection in their joints, hearts, or even brains`. Thankfully, none have yet died from this emerging disease.1027 [1231] R20;The demonstration of another new pathogen linked to the food industry is not surprising,R21; conclude the investigators, R20;considering that changes in the production, storage, distribution, and preparation of food, as well as environmental changes, provide increased opportunity for humans to be exposed to new organisms that may be pathogenic.R21;1028 [1232] Other pathogens emerging on aquaculture farms include a class that threatens immunocompromised persons in particular,1029 [1233] as well as wildlife pathogens escaping from hatcheries and threatening the survival of wild rainbow trout, for example, in many streams in the western United States.1030 [1234] The latest foodborne pathogen linked to poultry is R20;ExPEC.R21; Urinary tract infections (UTIs) are the most common bacterial infections in women of all ages,1031 [1235] affecting millions every year in the United States. From a physicianR17;s perspective, they are getting harder and harder to treat as antibiotic resistance among the chief pathogen, E. coli, becomes more and more common.1032 [1236] When most people think of E. coli infection, they think about the Jack-in-the-Box E. coli O157:H7 strain, which starts as hemorrhagic colitis (profuse bloody diarrhea) and can progress to kidney failure, seizures, coma, and death. While E. coli O157:H7 remains the leading cause of acute kidney failure in U.S. children,1033 [1237] fewer than 100,000 Americans get infected every year, and fewer than 100 die.1034 [1238] But millions get R20;extraintestinalR21; E. coli infectionsR12;urinary tract infections that can invade the bloodstream and cause an estimated 36,000 deaths annually in the United States.1035 [1239] ThatR17;s more than 500 times as many deaths as E. coli O157:H7. We know where E. coli O157:H7 comes fromR12;fecal contamination from the meat, dairy, and egg industries1036 [1240] R12;but where do these other E. coli come from? Medical researchers at the University of Minnesota published a clue to the mystery in the April 2005 issue of the Journal of Infectious Disease. Taking more than 1,000 food samples from multiple retail markets, they found evidence of fecal contamination in 69% of the pork and beef and 92% of the poultry samples as evidenced by E. coli contamination. More surprising was that more than 80% of the E. coli they recovered from beef, pork, and poultry were resistant to one or more antibiotics, and greater than half of the samples of poultry bacteria R20;were resistant to >5 drugs!R21; (One rarely finds exclamation points in the medical literature.) But what was most surprising was that half of the poultry samples were contaminated with the extraintestinal pathogenic E. coli bacteria, abbreviated ExPEC. UTI-type E. coli may be food-borne pathogens as well.1037 [1241] Scientists suspect that by eating chicken and other meat, women infect their lower intestinal tract with these antibiotic-resistant bacteria, which can then creep up into their bladder. Commonsense hygiene measures to prevent UTIs have included wiping from front to back after bowel movements and urinating after intercourse to flush out any infiltrators. Commenting on this body of research, Science News suggested meat avoidance as an option to R20;chicken outR21; of urinary tract infections.1038 [1242] Even if we ate vegetarian foods, though, we would still not be able to escape exposure to pathogens found in animal wastes. Apple cider freshly squeezed from apples collected in an orchard where an infected calf grazed caused an outbreak of cryptosporidiosis, a parasitic disease.1039 [1243] This was the same disease that caused a record 420,000 cases of severe gastroenteritis in the Milwaukee area in 1993, when cattle defecated upstream of a major source of the metropolitan water supply.1040 [1244] The alfalfa sprouts lining the whole-grain avocado sandwiches of the California health conscious led to a Salmonella outbreak in 2001.1041 [1245] Since the first reported sprout outbreak in 1973, there have been at least two dozen more in the United States,1042 [1246] including both Salmonella and E. coli O157:H7, infecting thousands of people.1043 [1247] How did chicken and cow bacteria get onto sprouts? It was contained in manure used as fertilizer.1044 [1248] As the level of infection in herd and flock feces has risen with intensification, so has the contamination of produce crops it has fertilized.1045 [1249] Even though spout producers may soak sprout seeds in a solution of bleach, pathogens seem able to hide inside microscopic crevices in the seeds. The latest outbreak in California led both the CDC and FDA to reiterate their recommendation that everyone cook their sprou1046 It is noteworthy that the CDC found only 32 people affected by the 2001 outbreak.1047 [1250] In 2005, the CDC released its latest estimate as to the number of Americans who get Salmonella from eggs every year. While sprouts have been associated with about 100 infections annually in the United States, eating eggs is estimated to sicken 182,000.1048 [1251] Tragically, food poisoning can be the gift that keeps on giving. Although thousands die from food poisoning every year in the United States, the vast majority suffer only acute, self-limited episodes. Up to 15% of those who contract Salmonella, however, go on to develop serious joint inflammation that can last for years. An estimated 100,000 to 200,000 Americans suffer from arthritis arising directly from foodborne infections every year.1049 [1252] One of the most feared, long-term complications of food poisoning is Guillain-Barré syndrome, in which infection with Campylobacter, a bacteria contaminating up to 98% of retail chicken meat in the United States,1050 [1253] can lead to being paralyzed for months on a ventilator.1051 [1254] With the virtual elimination of polio, poultry products are now the most common cause of acute flaccid paralysis in the developed world.1052 [1255] Campylobacter is a spiral-shaped poultry bacteria1053 [1256] that corkscrews its way into the lining of the intestine R20;with a speed that cannot be matched by other bacteria.R21;1054 [1257] Just as H. pylori bacteria has been linked to stomach cancer, Campylobacter, according to a 2004 report in the New England Journal of Medicine, may trigger cancer as well, a rare lymphoma of the intestines.1055 [1258] Campylobacter, not even proven to cause human illness until the 1970s,1056 [1259] is now the suspected cause of up to 25% of cases of irritable bowel syndrome1057 [1260] and is currently the number-one bacterial cause of food poisoning, sickening millions of Americans every year.1058 [1261] The bacteria in a single drop of chicken R20;juiceR21; is enough to make one sick1059 [1262] and can persist on a cutting board for hours.1060 [1263] The new U.S. meat inspection systemR12;HACCP (Hazard Analysis Critical Control Point system)R12;was originally designed by NASA and represents a welcome scientific departure from the century-old R20;poke and sniffR21; method.1061 [1264] Unfortunately, its implementation has been handed over to the industry guarding its own henhouses, leaving some USDA inspectors to deride HACCP as more of a R20;Have A Cup of Coffee and PrayR21; system.1062 [1265] R20;As an analogy,R21; says the president of the U.S. Meat Inspection Union, R20;imagine that as a driver you must write yourself a ticket every time you exceed the speed limit because youR17;re breaking the law. Some [chicken packing] plants cheat; others wonR17;t cheat until theyR17;re forced to in a competitive environmentR30;.R21;1063 [1266] Veterinarian and academician David Waltner-Toews writes in his book Food, Sex, and Salmonella, R20;The most serious problems [with foodborne disease] invariably come back to the willingness of pureblooded capitalists to take risks with other peopleR17;s lives.R21;1064 [1267] Few public health issues are more public than food safety, yet not only do the state and federal governments continue to lack the power to order mandatory recalls of contaminated meat, the meat and poultry industry donR17;t even have to divulge where the infected meat went. Federal agencies have more power to recall defective toys than meat. When the industry is left to do it voluntarily, less than half of the tainted meat is recovered. Following the largest meat recall in U.S. historyR12;R21;ready to eatR21; chicken and turkey products harboring Listeria bacteria1065 [1268] R12;the Government Accountability Office, the watchdog arm of Congress, called for an overhaul of the process in 2004, including granting the federal government mandatory meat recall authority.1066 [1269] Instead of cleaning up its own actR12;reducing the overcrowding of birds, relieving production stresses, and improving hygiene to lower infection ratesR12;the U.S. poultry industry has tended to push for more cost-effective alternatives, such as irradiation to kill off bacteria and viruses in the fecal material remaining on carcasses before they hit the store. One former USDA meat inspection administrator claims, R20;All irradiation will do is add partially decontaminated fecal matter to the American dietR30;. The solution to the food safety problem is to produce safe food.R21;1067 [1270] One novel solution that R20;holds great promiseR21; is the application of bacteria-destroying viruses to chicken meat, although the industry expressed concern over initial reports revealing R20;consumer resistanceR21; to the idea.1068 [1271] For a similar reason, the industry prefers the term R20;cold pasteurizationR21; to irradiation.1069 [1272] Another innovation the industry is considering to cover up its dirty secret of fecal contamination is R20;gluing shut the rectal cavities of turkeys and chicken broilersR21; in the slaughter plants before they hit the scalding tanks.1070 [1273] There are concerns, though, about glue residues contaminating the final product. Other ideas for sealing up the birdsR17; rectums include some type of mechanical plug or stapling technology.1071 [1274] The name of the poultry superglue product currently on the market is R20;Rectite(R).R21;1072 [1275] (c) BirdFluBook.com | Home [1276] | Website by Lantern Media [1277] Bird Flu - Offal Truth BirdFluBook.com [1278] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1279] Offal Truth Global public health experts have identified R20;dubious practices used in modern animal husbandryR21; beyond the inherent overstocking, stress, and filth that have directly or indirectly launched deadly new diseases.1073 [1280] One such R20;misguidedR21; brave new farm practice is the continued feeding of slaughterhouse waste, blood, and excrement to livestock to save on feed costs.1074 [1281] Feed expenditures remain the single largest industry expense.1075 [1282] The livestock industry has experimented with feeding newspaper, cardboard, cement dust, and sewer sludge to farm animals.1076 [1283] A U.S. News and World Report article summarized the gambit: R20;Cattle feed now contains things like manure and dead cats.R21;1077 [1284] The Animal Industry Association defends these practices, arguing that the average U.S. farm animal R20;eats better than the average U.S. citizen.R21;1078 [1285] Forcing natural herbivores like cows, sheep, and other livestock to be carnivores and cannibals turned out to have serious public health implications. A leading theory on the origin of mad cow disease is that cows got it by being fed diseased sheep.1079 [1286] In modern corporate agribusiness, protein concentrates (or R20;meat and bone meal,R21; euphemistic descriptions of R20;trimmings that originate on the killing floor, inedible parts and organs, cleaned entrails, fetusesR30;R21;1080 [1287] ) are fed to dairy cows to increase milk production,1081 [1288] as well as to most other livestock.1082 [1289] According to the World Health Organization, nearly ten million metric tons of slaughterhouse waste is fed to livestock every year.1083 [1290] The recycling of the remains of infected cattle into cattle feed was probably what led to the British mad cow epidemicR17;s explosive spread1084 [1291] to nearly two dozen countries around the world in the subsequent 20 years.1085 [1292] Dairy producers can use corn or soybeans as a protein feed supplement, but slaughterhouse by-products may be cheaper.1086 [1293] An editorial in the British Medical Journal described mad cow disease as resulting R20;from an accidental experiment on the dietary transmissibility of prion disease between sheep and cows.R21;1087 [1294] A subsequent R20;accidental experimentR21;R12;with humansR12;started in the late 1980s as meat contaminated with mad cow disease entered the human food supply.1088 [1295] PrionsR12;infectious proteinsR12;are the unconventional pathogens that cause mad cow-like diseases. Unlike other foodborne pathogens that can be treated with antibiotics and killed by proper cooking, prions are practically indestructible, surviving incineration1089 [1296] at temperatures hot enough to melt lead.1090 [1297] More than 100 young people have been killed in this "experiment" by the human form of mad cow disease, called variant Creutzfeldt-Jakob disease (vCJD),1091 [1298] whose standard clinical picture can involve weekly deterioration1092 [1299] into blindness and epilepsy1093 [1300] while the brain becomes riddled with holes.1094 [1301] vCJD produces a relentlessly progressive1095 [1302] and invariably fatal dementia.1096 [1303] As described in a 2004 review, R20;vCJD always results in death, and the disease process is highly dreadedR12;mute, blind, incontinent, immobile/paralyzed/bedriddenR30;.R21;1097 [1304] It may take decades between the act of eating infected meat and coming down with the initial symptoms of a vCJD death sentence.1098 [1305] The best available evidence suggests that as many as 1,000 more in Britain may be destined to die1099 [1306] with what BritainR17;s Secretary of Health called the R20;worse form of deathR21; imaginable.1100 [1307] A decade ago, the World Health Organization called for the exclusion of the riskiest bovine tissuesR12;cattle brains, eyes, spinal cord, and intestineR12;from the human food supply and from all animal feed.1101 [1308] Unfortunately, the United States still feeds some of these potentially risky tissues to people, pigs, pets, poultry, and fish.1102 [1309] Then pig remains can be fed back to cattle.1103 [1310] Cattle remains are still fed to chickens, and poultry litter (the mixture of excrement, spilled feed, dirt, feathers, and other debris that is scooped from the floors of broiler sheds1104 [1311] ) is fed back to cows.1105 [1312] In these ways, prions may continue to be cycled back into cattle feed and complete the cow R20;cannibalismR21; circuit. Ecologists assert that animal fecal wastes pose public health risks R20;similar to those of human wastes and should be treated accordingly,R21;1106 [1313] yet in animal agriculture today, fecal wastes are fed to other animals. Although excrement from other species is fed to livestock in the United States, chicken droppings are considered more nutritious for cows than pig feces or cattle dung.1107 [1314] Because poultry litter can be as much as eight times cheaper than foodstuffs like alfalfa,1108 [1315] the U.S. cattle industry feeds poultry litter to cattle.1109 [1316] A thousand chickens can make enough waste to feed a growing calf year round.1110 [1317] A single cow can eat as much as three tons of poultry waste a year,1111 [1318] yet the manure does not seem to affect the taste of the subsequent milk or meat.1110 [1319] Taste panels have found little difference in the tenderness, juiciness, and flavor of beef from steers fed up to 50% poultry litter. Beef from animals fed bird droppings may in fact even be more juicy and tender.1113 [1320] Cows are typically not given feed containing more than 80% poultry litter, though, since itR17;s not as palatable1114 [1321] and may not fully meet protein and energy needs.1115 [1322] The industry realizes that the practice of feeding poultry manure to cattle might not stand up to public scrutiny. They understand that the custom carries R20;certain stigmas,R21;1116 [1323] R20;presents special consumer issues,R21;1117 [1324] and poses R20;potential public relations problems.R21;1118 [1325] They seem puzzled as to why the public so R20;readily accepts organically grown vegetablesR21; grown with composted manure, while there is R20;apparent reluctance on the part of the publicR21; to accept the feeding of poultry litter to cattle.1119 [1326] R20;We hope,R21; says one industry executive, R20;common sense will prevail.R21;1120 [1327] The editor of Beef magazine commented, R20;The public sees it as R16;manure.R17; We can call it what we want and argue its safety, feed value, environmental attributes, etc., but outsiders still see it simply as R16;chicken manure.R17; And, the most valid and convincing scientific argument isnR17;t going to counteract a gag reflex.R21;1121 [1328] The industryR17;s reaction, then, has been to silence the issue. According to Beef, public relations experts within the National CattlemenR17;s Beef Association warned beef producers that discussing the issue publicly would only R20;bring out more adverse publicity.R21;1122 [1329] When the Kansas Livestock Association dared to shine the spotlight on the issue by passing a resolution urging the discontinuation of the practice, irate producers in neighboring states threatened a boycott of Kansas feed-yards.1123 [1330] In compliance with World Health Organization guidelines, Europe has forbidden the feeding of all slaughterhouse and animal waste to livestock.1124 [1331] The American Feed Industry Association called such a ban R20;a radical proposition.R21;1125 [1332] The American Meat Institute agreed, stating, R20;[N]o good is accomplished byR30;prejudicing segments of society against the meat industry.R21;1126 [1333] As far back as 1993, Gary Weber, director of Beef Safety and Cattle Health for the National CattlemenR17;s Beef Association, admitted that the industry could find economically feasible alternatives to feeding rendered animal protein to other animals, but that the CattlemenR17;s Association did not want to set a precedent of being ruled by R20;activists.R21;1127 [1334] Gary Weber was the beef industry spokesperson who appeared on the infamous Oprah Winfrey show in 1996. An internal U.S. government PR crisis management document showed that the government knew such feeding practices would be R20;vulnerable to media scrutiny.R21;1128 [1335] Indeed, alarmed and disturbed that cows in the United States are fed the remains of other cattle, Oprah swore she would never eat another burger.1129 [1336] After Oprah tried to remind the audience that cows were supposed to be herbivores, Weber defended the practice by stating, R20;Now keep in mind, before youR12;you view the ruminant animal, the cow, as simply a vegetarianR12;remember that they drink milk.R21;11130 [1337] The absurdity of the statement aside, itR17;s not even accurate. In modern agribusiness, humans drink the milk. Calves typically get milk R20;replacer.R21; Like all mammals, cows can only produce milk after theyR17;ve had a baby. Most newborn calves in the United States are separated from their mothers within 12 hoursR12;many immediately after birthR12;so the motherR17;s milk can be marketed for human consumption.1131 [1338] Though some dairy farmers still wean calves on whole milk, the majority of producers use milk replacer,1132 [1339] which too often contains spray-dried cattle blood as a cheap source of protein.1133 [1340] The chief disadvantage of blood-based milk replacer, according to the vice president of product development for the Animal Protein Corporation, is simply its R20;different color.R21; Milk replacer containing blood concentrate typically has a R20;chocolate brownR21; color which can leave a dark residue on the bottles, buckets, and utensils used to feed the liquid.1134 [1341] R20;For some producers,R21; the company official remarked, R20;the difference is difficult to accept at first, since the product does not look R16;like milk.R17;R21; But the R20;[c]alves donR17;t care,R21; he was quick to add.1135 [1342] The calves may not care, but Stanley Prusiner does. Prusiner won the Nobel Prize in Medicine for his discovery of prions. He was quoted in the New York Times as calling the practice of feeding cattle blood to young calves R20;a really stupid idea.R21;1136 [1343] The European Commission also condemned the practice of R20;intraspecies recycling of ruminant blood and blood productsR21;R12;the practice of suckling calves on cowsR17; blood protein.1137 [1344] Even excluding the fact that brain emboli may pass into the trough that collects the blood once an animalR17;s throat is slit,1138 [1345] the report concludes, R20;As far as ruminant blood is concerned, it is considered that the best approach to protect public health at present is to assume that it could contain low levels of infectivity.R21;1139 [1346] Calves in the United States are still drinking up to three cups of R20;red blood cell proteinR21; concentrate every day.1140 [1347] The American Protein Corporation is the largest spray-dryer of blood in the world1141 [1348] and advertises blood products that can even be fed R20;through the drinking waterR21; to calves and pigs.1142 [1349] The majority of pigs in the United States are raised in part on spray-dried blood meal.1143 [1350] According to the National Renderers Association, although young pigs may find spray-dried blood meal initially unpalatable, they eventually get used to it.1144 [1351] Dateline NBC quoted D. Carleton Gajdusek, the first to be awarded a Nobel Prize in Medicine for his work on prion diseases,1145 [1352] as saying, R20;[I]tR17;s got to be in the pigs as well as the cattle. ItR17;s got to be passing through the chickens.R21;1146 [1353] Paul Brown, medical director for the U.S. Public Health Service, also believes that pigs and poultry could be harboring mad cow disease and passing it on to humans, adding that pigs are especially sensitive to the disease. R20;ItR17;s speculation,R21; he says, R20;but I am perfectly serious.R21;1147 [1354] Since 1996, the World Health Organization has recommended that all countries stop feeding remains of cows to cows, yet the U.S. government still allows dairy farmers to feed calves gallons of a mixture of concentrated cow blood and fat collected at the slaughterhouse.1148 [1355] Industry representatives continue to actively support this practice.1149 [1356] R20;It was the farmersR17; fault,R21; one young victim whispered to her mother from the bed where she waged and lost a painful, prolonged battle against vCJD.1150 [1357] Since 1996, the World Health Organization has recommended that all countries test their downed cattleR12;those animals too sick or crippled even to walkR12;for mad cow disease, yet the U.S. government tests but a fraction of this high-risk population. The beef industry calls U.S. surveillance R20;aggressiveR21;1151 [1358] and doesnR17;t think more testing is necessary.1152 [1359] Stanley Prusiner, the worldR17;s authority on these diseases, calls U.S. surveillance R20;appalling.R21;1153 [1360] Since 1996, the World Health Organization has recommended that all countries stop feeding risky cattle organs (like brains) to all livestock. The Food and Agriculture Organization of the United Nations agrees with this no-brainer.1154 [1361] The U.S. government continues to violate these guidelines. The American Meat Institute and 14 other industry groups vocally oppose such a ban.1155 [1362] The British governmentR17;s Official Inquiry into mad cow disease (also known as bovine spongiform encephalopathy, or BSE) concluded: R20;BSE developed into an epidemic as a consequence of an intensive farming practiceR12;the recycling of animal protein in ruminant feed. This practice, unchallenged over decades, proved a recipe for disaster.R21;1156 [1363] True, it is hard to predict disease consequences of new innovations. Consider the tampon. R20;Devised to reduce a womanR17;s monthly inconvenience,R21; National Institutes of Health researchers wrote, R20;it provided a rich culture medium for Staphylococcus aureus and as a result killed many [through toxic shock syndrome].R21;1157 [1364] The meat industry has long known that cannibalistic feeding practices could be harmful, though, as Salmonella epidemics in poultry linked to the recycling of animal remains back into animal feed had been described well before the mad cow disease epidemic.1158 [1365] Even if the meat industry didnR17;t realize the scope of the potential human hazard then, it certainly should now. Yet it remains opposed to a total ban on the feeding of slaughterhouse waste, blood, and excrement to farm animals.1159 [1366] Journalism professor Mark Jerome Walters returned to the scene of mad cow diseaseR17;s birth in rural England. The farmer who harbored the first discovered case confessed: In retrospect, IR17;m appalled at what I didnR17;t know about my own cows. I didnR17;t know they were being fed other cows and sheep that had been ground into a powder. WeR17;ve forced these hoofed grazers into cannibalism. On some farms theyR17;re fed growth promotants, and thatR17;s probably causing other problems. In many places in the world, livestock are kept in deplorable conditions, all for convenience and profit. WeR17;ve put cows on an assembly line and we take them off at the other end and butcher them. Did we really think we could just rearrange the world in any way we pleased? Nobody could have wished for or foreseen this awful thing called BSE. But should we be all that surprised?1160 [1367] (c) BirdFluBook.com | Home [1368] | Website by Lantern Media [1369] Bird Flu - Big Mac Attack BirdFluBook.com [1370] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1371] Big Mac Attack Brianna Kriefall, E. coli victim Unnatural feeding practices have also been blamed for the emergence of the E. coli O157:H7, best known for the 1993 Jack-in-the-Box outbreak that infected more than 500 kids and adults when burgers contaminated with infectious fecal matter were distributed to 93 restaurants.1161 [1372] McDonaldR17;s, however, was ground zero for the first E. coli O157:H7 outbreak the decade before.1162 [1373] A mother offers an eyewitness account of what the bug did to her eight-year-old daughter, Brianne: The pain during the first 80 hours was horrific, with intense abdominal cramping every 10 to 12 minutes. Her intestines swelled to three times their normal size and she was placed on a ventilator. Emergency surgery became essential and her colon was removed. After further surgery, doctors decided to leave the incision open, from sternum to pubis, to allow BrianneR17;s swollen organs room to expand and prevent them from ripping her skin. Her heart was so swollen it was like a sponge and bled from every pore. Her liver and pancreas shut down and she was gripped by thousands of convulsions, which caused blood clots in her eyes. We were told she was brain dead.1163 [1374] Brianne did survive, though suffering permanent kidney, liver, and brain damage.1164 [1375] Alexander Thomas Donley, age six, did not. He stopped screaming only after E. coli toxins destroyed his brain before his death. R20;I was so horrified and so shocked and so angered by what happened to him,R21; said his mother Nancy, now president of Safe Tables Our Priority, a Chicago-based advocacy organization. She continued, I had no idea that there was any problem in our food supply. I loved my child more than anything in this world. And then to find out that he died because there were contaminated cattle feces in a hamburger. And to find out that had been recognized as a problem for a while. Why hadnR17;t it been fixed? Later, when testifying before a congressional subcommittee, a Senator repeated to her the same line she had heard countless times before, that the United States has the safest food supply in the world. Nancy Donley stared up at him and said, R20;Senator, I beg to differ with you.R21;1165 [1376] Nancy was right. Steve Bjerklie, as editor of the U.S. trade journal Meat and Poultry, described the industryR17;s R20;mantraR21;: R20;ItR17;s spoken by dozens of industry leaders and government regulators, even intoned by fact-finding academicians who should know better,R21; he wrote. R20;Over and over, at convention after convention, meeting after meeting, one hears the words droned by industry speaker after industry speaker, as if the existence of the words as sound waves in the air confirmed their truth: R16;We have the safest meat and poultry supply in the world.R17;R21;1166 [1377] Unfortunately, he admits, the facts donR17;t support the claim. Most European nations donR17;t allow profitable but risky practices like the chilling baths that add water weightR12;and bacteriaR12;to poultry in the United States. SwedenR17;s poultry is virtually Salmonella-free. In Sweden, itR17;s not just a good idea, itR17;s the law, and has been since 1968 after a Salmonella outbreak caused 9,000 illnesses.1167 [1378] In the United States, eggs continue to infect more than 150,000 Americans annually.1168 [1379] The U.S. industry trade group United Egg Producers openly brags about obstructing public health measures, crowing in its R20;Washington ReportR21; that it added language to the USDA inspection budget that effectively killed the Salmonella testing program.1169 [1380] According to Marion Nestle, former director of Nutrition Policy at the U.S. Department of Health and Human Services and a longtime chair of the nutrition department at New York University, R20;Major food industries oppose pathogen-control measures by every means at their disposal.R21;1170 [1381] In the United States, Salmonella is on the rise. The USDA recently reported an 80% increase in the number of chickens contaminated with Salmonella since 2000. The chair of the department of epidemiology at the University of Maryland School of Medicine and former official in the USDAR17;s Food Safety and Inspection Service told the New York Times in March 2006 that when it comes to poultry products, R20;[i]t continues to be buyer beware.R21;1171 [1382] The NetherlandsR17; E. coli O157:H7 testing program, according to Bjerklie, R20;makes USDAR17;s look like quality control at the R16;Laverne and ShirleyR17; brewery.R21; This may be because their meat inspection program falls under the NetherlandsR17; Ministry of Health, not the Ministry of Agriculture.1172 [1383] As far back as 1979, the National Research Council,1173 [1384] the Government Accountability Office,1174 [1385] the Institute of Medicine1175 [1386] R12;and even the conservative Food Marketing Institute1176 [1387] R12;have called for the formation of an independent food safety authority similar to what exists in Europe, but to no avail.1177 [1388] In 2002, ConAgra recalled 19 million pounds of E. coli O157:H7-contaminated ground beef in one of the biggest meat recalls in U.S. history,1178 [1389] yet it raised little public alarm. Where was the beef? R20;If 19 million pounds of meat distributed to half of this country had been contaminated with a deadly strain of E. coli bacteria by terrorists,R21; wrote one columnist, R20;weR17;d go nuts. But when itR17;s done by a Fortune 100 corporation, we continue to buy it and feed it to our kids.R21;1179 [1390] Given the alleged collusion between industry and government,1180 [1391] parents are forced to take responsibility. One public health official put it bluntly: Somebody had to come right out and say, because it wasnR17;t getting said because people were tiptoeing around the issue, R20;Parents, if youR17;ve got a child in a hospital laying there with [organ failure]R30;and youR17;re the one who served them red hamburger, youR17;re as responsible for the illness as if you had put them in the front seat of a car without a seat belt or a car seat and drove 90 miles an hour through red lights.R21;1181 [1392] This sentiment is typical of the industryR17;s blame-the-victim attitude. A more appropriate analogy might be sitting oneR17;s child in a pre-1970s car with no seatbelts before the consumer movement forced auto makers to include them. E. coli O157:H7 means children can now die from going to a petting zoo.1182 [1393] Since 1990, the CDC has reported more than two dozen separate outbreaks in children linked to petting zoos.1183 [1394] There is no reason for anyoneR17;s children to get E. coli poisoning from this or any other source. E. coli O157:H7, like many of these other new diseases, is thought to be a by-product of our new intensive confinement system of animal agribusiness. The changes in the digestive tracts of cattle fattened in feedlots with energy-dense grain to marble the flesh with saturated fat (instead of natural cattle foodstuffs like hay) has been blamed for the emergence of E. coli O157:H7. Grain-fed beef may be more tender, but grass-fed beef may be safer.1184 [1395] In a familiar refrain, instead of altering feeding practices or eliminating the crowded feedlots that lead to manure-encrusted hides, the industry has decided itR17;s more cost-effective to invest in chemical carcass dehairing technologies to lessen fecal contamination.1185 [1396] Cost-effective, perhaps, as long as childrenR17;s lives are not figured into the bottom line. (c) BirdFluBook.com | Home [1397] | Website by Lantern Media [1398] Bird Flu - Animal Bugs Forced to Join the Resistance BirdFluBook.com [1399] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1400] Animal Bugs Forced to Join the Resistance At the American Chemical Society annual meeting in Philadelphia in 1950, the business of raising animals for slaughter changed overnight. Scientists announced the discovery that antibiotics make chickens grow faster.1186 [1401] By 1951, the FDA approved the addition of penicillin and tetracycline to chicken feed as growth promotants, encouraging pharmaceutical companies to mass-produce antibiotics for animal agriculture. Antibiotics became cheap growth enhancers for the meat industry.1187 [1402] Healthy animals raised in hygienic conditions do not respond in the same way. If healthy animals housed in a clean environment are fed antibiotics, their growth rates donR17;t change. Factory farms are considered such breeding grounds for disease that much of the animalsR17; metabolic energy is spent just staying alive under such filthy, crowded, stressful conditions;1188 [1403] normal physiological processes like growth are put on the back burner.1189 [1404] Reduced growth rates in such hostile conditions cut into profits, but so would reducing the overcrowding. Antibiotics, then, became another crutch the industry can use to cut corners and cheat nature.1190 [1405] Mother Nature, however, does not stay cheated for long. The poultry industry, with its extreme size and intensification, continues to swallow the largest share of antibiotics. By the 1970s, 100% of all commercial poultry in the United States were being fed antibiotics. By the late 1990s, poultry producers were using more than ten million pounds of antibiotics a year.1191 [1406] So many antibiotics are fed to poultry that there have been reports of chickens dying from antibiotic overdoses.1192 [1407] These thousands of tons of antibiotics are not going to treat sick animals; more than 90% of the antibiotics are used just to promote weight gain.1193 [1408] The majority of the antibiotics produced in the world go not to human medicine but to prophylactic usage on the farm.1194 [1409] This may generate antibiotic resistance. When one saturates an entire broiler chicken shed with antibiotics, this kills off all but the most resistant bugs, which can then spread and multiply. When Chinese chicken farmers put amantadine into their flocksR17; water supply, there was a tremendous environmental pressure on the virus to mutate resistance to the antiviral. Say thereR17;s a one in a billion chance of an influenza virus developing resistance to amantadine. Odds are, any virus we would come in contact with would be sensitive to the drug. But each infected bird poops out more than a billion viruses every day.1195 [1410] The rest of their viral colleagues may be killed by the amantadine, but that one resistant strain of virus will be selected to spread and burst forth from the chicken farm, leading to widespread viral resistance and emptying our arsenal against bird flu. The same principles apply to the feeding of other antimicrobials.1196 [1411] According to the CDC, at least 17 classes of antimicrobials are approved for food animal growth promotion in the United States,1197 [1412] including many families of antibiotics, such as penicillin, tetracycline, and erythromycin, that are critical for treating human disease.1198 [1413] As the bugs become more resistant to the antibiotics fed to healthy chickens, they may get more resistant to the antibiotics needed to treat sick people. According to the World Health Organization, the livestock industry is helping to breed antibiotic-resistant pathogens.1199 [1414] R20;The reason weR17;re seeing an increase in antibiotic resistance in foodborne diseases,R21; explains the head of the CDCR17;s food poisoning surveillance program, R20;is because of antibiotic use on the farm.R21;1200 [1415] The industry continues to deny culpability.1201 [1416] The European science magazine New Scientist editorialized that the use of antibiotics to make animals grow faster R20;should be abolished altogether.R21; That was in 1968.1202 [1417] Pleas for caution in the overuse of antibiotics can be traced back farther to Sir Alexander Fleming himself, the inventor of penicillin, who told the New York Times in 1945 that inappropriate use of antibiotics could lead to the selection of R20;mutant formsR21; resistant to the drugs.1203 [1418] While Europe banned the use of many medically important antibiotics as farm animal growth promoters years ago,1204 [1419] no such comprehensive step has yet taken place in the United States. Two of the most powerful lobbies in Washington, the pharmaceutical industry and the meat industries, have fought bitterly against efforts by the World Health Organization,1205 [1420] the American Medical Association,1206 [1421] and the American Public Health Association1207 [1422] to enact a similar ban in the United States.1208 [1423] Donald Kennedy, the editor-in-chief of Science, wrote that the continued feeding of medically important antibiotics to farm animals to promote growth goes against a R20;strong scientific consensus that it is a bad idea.R21;3189 [1424] An editorial the same year in the New England Journal of Medicine entitled, R20;Antimicrobial Use in Animal Feed--Time to Stop,R21; came to a similar conclusion.3190 [1425] Despite the consensus among the worldR17;s scientific authorities, debate on this issue continues. The editorial board of the Nature microbiology journal offered an explanation: R20;A major barrier is the fact that many scientists involved in agriculture and food animal producers refuse to accept that the use of antibiotics in livestock has a negative effect on human health. It is understandable that the food-producing industry wishes to protect its interests. However, microbiologists are aware of, and understand, the weight of evidence linking the subtherapeutic use of antibiotics with the emergence of resistant bacteria. Microbiologists also understand the threat that antibiotic resistance poses to public health. As a profession, we must be vocal in supporting any policy that diminishes this threat.R21;3191 [1426] An editorial in the Western Journal of Medicine identified erroneous claims made by the pharmaceutical and meat industries and concluded: R20;The intentional obfuscation of the issue by those with profit in mind is an uncomfortable reminder of the long and ongoing battle to regulate the tobacco industry, with similar dismaying exercises in political and public relations lobbying and even scandalR21;3192 [1427] The U.S. Government Accountability Office released a 2004 report on the use of antibiotics in farm animals. Though they acknowledge that R20;[m]any studies have found that the use of antibiotics in animals poses significant risks for human health,R21; the GAO notably did not recommend banning the practice,1209 [1428] as a ban on the use of antibiotics as growth promoters could in part result in a R20;reduction of profitsR21; for the industry. Even a partial ban would R20;increase costs to producers, decrease production, and increase retail prices to consumers.R21; An unsubstantiated industry estimate3194 [1429] of the costs associated with a total ban on the widespread feeding of antibiotics to farm animals in the United States would be an increase in the price of poultry anywhere from 1 to 2 cents per pound and the price of pork or beef around 3 to 6 cents a pound, costing the average meat-eating American consumer up to $9.72 a year.1210 [1430] Antibiotic-resistant infections in the United States cost an estimated $30 billion every year1211 [1431] and kill 90,000 people.1212 [1432] A major analysis of the elimination of growth-promoting antibiotics in Denmark, one of the worldR17;s largest pork producers, showed that the move led to a marked reduction in bacterial antibiotic-resistance without significant adverse effects on productivity.3195 [1433] U.S. industry, however, has argued that the Danish experience cannot be extrapolated to the United States. This led Johns Hopkins University researchers to carry out an economic analysis based on data from Perdue, one of the largest poultry producers in the United States. The Johns Hopkins University Bloomberg School of Public Health study, published in 2007, examined data from seven million chickens and concluded that the use of antibiotics in chicken feed increases costs of poultry production. R20;Contrary to the long-held belief that a ban against GPAs [growth-promoting antibiotics] would raise costs to producers and consumers,R21; the researchers concluded, R20;these results using a large-scale industry study demonstrate the opposite.R21; They found that the conditions in PerdueR17;s facilities were such that antibiotics did accelerate the birdsR17; growth rates, but the money saved was insufficient to offset by the cost of the antibiotics themselves. Growth-promoting antibiotics may end up costing producers more in the end than if they hadnR17;t used antibiotics at all. A similar study at Kansas State University also showed no economic benefits from feeding antibiotics to fattening pigs.3196 [1434] The drug companies, though, stand to lose a fortune. When the FDA first considered revoking the license for the use of antibiotics strictly as livestock growth promoters, the drug industry went hog wild. Thomas H. Jukes, a drug industry official formerly involved with one of the first commercial producers of antibiotics for livestock, blamed the FDAR17;s consideration on a R20;cult of food quackery whose high priests have moved into the intellectual vacuum caused by the rejection of established values.R21; Jukes was so enamored with the growth benefits he saw on industrial farms that he advocated antibiotics be added to the human food supply. R20;I hoped that what chlortetracycline did for farm animals it might do for children.R21; We should especially feed antibiotics to children in the Third World, he argued, to compensate for their unhygienic overcrowding, which he paralleled to the conditions R20;under which chickens and pigs are reared intensively.R21;1213 [1435] R20;Children grow far more slowly than farm animals,R21; he wrote. R20;Nevertheless, there is still a good opportunity to use low-level feeding with antibioticsR30;among children in an impoverished condition.R21;1214 [1436] The poultry industry blames the dramatic rise in antibiotic-resistant bacteria on the overprescription of antibiotics by doctors.1215 [1437] While doctors undoubtedly play a role, according to the CDC, more and more evidence is accumulating that livestock overuse is particularly worrisome.1216 [1438] Take, for example, the recent September 2005 FDA victory against the Bayer Corporation.1217 [1439] Typically, Campylobacter causes only a self-limited diarrheal illness (R20;stomach fluR21;) which doesnR17;t require antibiotics. If the gastroenteritis is particularly severe, though, or if doctors suspect that the bug may be working its way from the gut into the bloodstream, the initial drug of choice is typically a quinolone antibiotic like Cipro. Quinolone antibiotics have been used in human medicine since the 1980s, but widespread antibiotic-resistant Campylobacter didnR17;t arise until after quinolones were licensed for use in chickens in the early 1990s. In countries like Australia, which reserved quinolones for human use only, resistant bacteria are practically unknown.1218 [1440] The FDA concluded that the use of Cipro-like antibiotics in chickens compromised the treatment of nearly 10,000 Americans a year, meaning that thousands infected with Campylobacter who sought medical treatment were initially treated with an antibiotic to which the bacteria was resistant, forcing the doctors to switch to more powerful drugs.1219 [1441] Studies involving thousands of patients with Campylobacter infections showed that this kind of delay in effective treatment led to up to ten times more complicationsR12;infections of the brain, the heart, and, the most frequent serious complication they noted, death.1220 [1442] When the FDA announced that it was intending to join other countries and ban quinolone antibiotic use on U.S. poultry farms, the drug manufacturer Bayer initiated legal action that successfully hamstrung the process for five years.1222 [1443] During that time, Bayer continued to corner the estimated $15 million a year market,1221 [1444] playing its game of chicken with AmericaR17;s health while resistance continued to climb.3188 [1445] Meanwhile, poultry factories continue to spike the water and feed supply with other antibiotics critical to human medicine. Evidence released in 2005 found that retail chicken samples from factories that used antibiotics are more than 450 times more likely to carry antibiotic-resistant bugs. Even companies like Tyson and Perdue, which supposedly stopped using antibiotics years ago, are still churning out antibiotic-resistant bacteria-infected chicken. Scientists think bacteria that became resistant years before are still hiding within the often dirt floors of the massive broiler sheds or within the water supply pipes. Another possibility is that the carcasses of the chickens raised under so-called R20;Antibiotic FreeR21; conditions are contaminated with resistant bacteria from slaughterhouse equipment that can process more than 200,000 birds in a single hour.1223 [1446] Relying on the poultry industry to police itself may not be prudent. This is the same industry that pioneered the use of the synthetic growth hormone diethylstilbestrol (DES) to fatten birds and wallets despite the fact that it was a known carcinogen. Although some women were prescribed DES during pregnancyR12;a drug advertised by manufacturers to produce R20;bigger and stronger babiesR21;1124 [1447] R12;the chief exposure for the American people to DES was through residues in meat. Even after it was proven that women who were exposed to DES gave birth to daughters plagued with high rates of vaginal cancer, the meat industry was able to stonewall a ban on DES in chicken feed for years.1225 [1448] According to a Stanford University health policy analyst, only after a study found DES residues in marketed poultry meat at 342,000 times the levels found to be carcinogenic did the FDA finally ban it as a growth promotant in poultry in 1979.1226 [1449] Science editor-in-chief Dr. Kennedy, who served as commissioner of the U.S. Food and Drug Administration, describes the antibiotic debate as a R20;struggle between good science and strong politics.R21; When meat production interests pressured Congress to shelve an FDA proposal to limit the practice, Kennedy concluded: R20;Science lost.R21;2193 [1450] The industry defends its antibiotic-feeding practices. Before BayerR17;s antibiotic was banned, a National Chicken Council spokesperson told a reporter, R20;It improves the gut health of the bird and its conversion of feed, what we call the feed efficiency ratioR30;. And if we are what we eat, weR17;re healthier if theyR17;re healthier.R21;1227 [1451] Chickens in modern commercial production are profoundly unhealthy. Due to growth-promoting drugs and selective breeding for rapid growth, many birds are crippled by painful leg and joint deformities.1228 [1452] The industry journal Feedstuffs reports that R20;broilers now grow so rapidly that the heart and lungs are not developed well enough to support the remainder of the body, resulting in congestive heart failure and tremendous death losses.R21;1229 [1453] The reality is that these birds exist under such grossly unsanitary conditions, cramped together in their own waste, that the industry feels forced to lace their water supply with antibiotics. R20;Present production is concentrated in high-volume, crowded, stressful environments, made possible in part by the routine use of antibacterials in feed,R21; the congressional Office of Technology Assessment wrote as far back as 1979. R20;Thus the current dependency on low-level use of antibacterials to increase or maintain production, while of immediate benefit, also could be the AchillesR17; heel of present production methods.R21;1230 [1454] In June 2005, the CDC released data showing that antibiotic-resistant Salmonella has led to serious complications.1231 [1455] Foodborne Salmonella emerged in the Northeast in the late 1970s and has spread throughout North America. One theory holds that multidrug-resistant Salmonella was disseminated worldwide in the 1980s via contaminated feed made out of farmed fish fed routine antibiotics,1232 [1456] a practice condemned by the CDC.1233 [1457] Eggs are currently the primary vehicle for the spread of Salmonella bacteria to humans, causing an estimated 80% of outbreaks. The CDC is especially concerned about the recent rapid emergence of a strain resistant to nine separate antibiotics, including the primary treatment used in children.1234 [1458] Salmonella kills hundreds of Americans every year, hospitalizes thousands,1234 [1459] and sickens more than a million.1236 [1460] The Director-General of the World Health Organization fears that this global rise in antibiotic-resistant R20;superbugsR21; is threatening to R20;send the world back to a pre-antibiotic age.R21;1237 [1461] As resistant bacteria sweep aside second- and third-line drugs, the CDCR17;s antibiotic-resistance expert says that R20;weR17;re skating just along the edge.R21;1238 [1462] The bacteria seem to be evolving resistance faster than our ability to create new antibiotics. R20;It takes us 17 years to develop an antibiotic,R21; explains a CDC medical historian. R20;But a bacterium can develop resistance virtually in minutes. ItR17;s as if weR17;re putting our best players on the field, but the bench is getting empty, while their side has an endless supply of new players.R21;1239 [1463] Remarked one microbiologist, R20;Never underestimate an adversary that has a 3.5 billion-year head start.R21;1240 [1464] For critics of the poultry industry, the solution is simple. R20;It doesnR17;t take rocket science,R21; said the director of the Union of Concerned ScientistsR17; food division, R20;to create the healthy, non-stressful conditions that make it possible to avoid the use of antibiotics.R21;1241 [1465] The trade-off is between immediate economic benefit for the corporations and longer-term risks shared by us all, a theme that extends to the control of avian influenza.1242 [1466] In 2004, the Worldwatch Institute published an article, R20;Meat: Now, itR17;s not personal!R21;1243 [1467] They were alluding to intensive methods of production that have placed all of us at risk, regardless of what we eat. In the age of antibiotic resistance, a simple scrape can turn into a mortal wound and a simple surgical procedure can be anything but simple. But at least these R20;superbugsR21; are not effectively spread from person to person. Given the propensity of factory farms to churn out novel lethal pathogens, though, what if they produced a virus capable of a global pandemic? (c) BirdFluBook.com | Home [1468] | Website by Lantern Media [1469] Bird Flu - Last Great Plague BirdFluBook.com [1470] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1471] Last Great Plague The latest National Academy of Sciences report investigating the rising tide of new diseases spoke of myriad factors creating the microbial equivalent of a R20;perfect storm.R21; R20;However, unlike a major climactic event where various meteorologic forces converge to produce a tempest,R21; it reads, R20;this microbial perfect storm will not subside. There will be no calm after the epidemic; rather the forces combining to create the perfect storm will continue to collide and the storm itself will be a recurring event.R21;1244 [1472] And there is no storm like influenza. The dozens of emerging zoonotic disease threats that have characterized this third era of human disease must be put into context. SARS infected thousands of human beings and killed hundreds. Nipah only infected hundreds and killed scores. Strep. suis infected scores and only killed dozens. Influenza infects billions and can kill millions. Influenza, the R20;last great plague of man,R21;1245 [1473] is the only known pathogen capable of truly global catastrophe.1246 [1474] Unlike other devastating infections like malaria, which is confined equatorially, or HIV, which is only fluid-borne, influenza is considered by the CDCR17;s Keiji Fukuda to be the only pathogen carrying the potential to R20;infect a huge percentage of the worldR17;s population inside the space of a year.R21;1247 [1475] R20;Make no mistake about it,R21; Osterholm says. R20;Of all the infectious diseases influenza is the lion king.R21;1248 [1476] Because of its extreme mutation rate, influenza is a perpetually emerging disease. Anthony Fauci, the NIHR17;s pandemic planning czar, calls it R20;the mother of all emerging infections.R21;1249 [1477] In its 4,500 years infecting humans since the first domestication of wild birds, influenza has always been one of the most contagious pathogens.1250 [1478] Only since 1997 has it also emerged as one of the deadliest. If influenza is the king of all emerging infections, H5N1 is the king of kings. H5N1 seems a full order of magnitude more lethal than every known human influenza virus on record, completely off the charts. To reduce the risk of future escalating pandemics, we must trace its origin in greater detail to understand how a monster like H5N1 could be hatched. (c) BirdFluBook.com | Home [1479] | Website by Lantern Media [1480] Bird Flu - PandoraR17;s Pond BirdFluBook.com [1481] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1482] PandoraR17;s Pond Prior to Graeme Laver and Robert WebsterR17;s landmark experimental work proving the avian origin of human influenzaR12;WebsterR17;s self-described R20;barnyard theoryR21;1251 [1483] R12;any links between bird flu and human flu were scoffed at, Laver remembers, as R20;scornful remarks about R16;Webster and his obsession with chicken influenza.R17;R21;1252 [1484] No one is scoffing anymore. Analyzing the genome of H5N1, scientists now suspect that the 1997 outbreak arose when an H5 goose virus combined with an N1 duck virus with quail acting as the mixing vessel (another species R20;raised under battery conditionsR21;1253 [1485] ). The virus then jumped from quail to chickens and then from chickens to humans.1254 [1486] In 2001, in what seems to be a separate emergence, that same H5 goose virus combined with an N1 duck virus in a duck, then jumped to chickens directly, bypassing the quail.1255 [1487] In both cases, the H5 virus first isolated from a farmed domestic goose population in Guangdong province was found,1256 [1488] surprisingly, to be already partially adapted to mammals.1257 [1489] Scientists speculate that this could have been a result of the virus acclimating to a pig, especially, perhaps, given AsiaR17;s unique fish-farming technique.1258 [1490] Pig-hen-fish aquaculture involves perching battery cages of chickens directly over feeding troughs in pig pens which in turn are positioned above fish ponds. The pigs eat the bird droppings and then defecate into the ponds. Depending on the species of fish, the pig excrement is then eaten directly by the fish1259 [1491] or acts as fertilizer for aquatic plant fish food.1260 [1492] The pond water can then be piped back up for pig and chicken drinking water.1261 [1493] The efficiency of integrated aquaculture in terms of reduced feed and waste disposal costs is considered key to the economics of chicken farming in some areas in Asia,1262 [1494] and, as such, led to increasing support from international aid agencies.1263 [1495] R20;The result,R21; wrote experts from the German Institute for Virology in the science journal Nature, R20;may well be creation of a considerable potential human health hazardR30;.R21;1264 [1496] In parts of Asia, human feces are also added to the ponds for additional enrichment.1265 [1497] For pathogens spread via a fecal-oral route, this aquaculture system is a dream come true. These fully integrated systems are blamed for the high incidence of an emerging strain1266 [1498] of cholera in shrimp farmed in the Calcutta region of India.1267 [1499] According to aquaculture experts, rampant disease on Asian aquaculture farms is considered the primary constraint to the industryR17;s growth. They write in a 2005 review that R20;the aquaculture industry has been overwhelmed with its share of diseases and problems caused by viruses, bacteria, fungi, parasites, and other undiagnosed and emerging pathogens.R21;1268 [1500] Concludes an earlier review, R20;Although the recycling of excrements in integrated agriculture-aquaculture farming systems offers many advantages, the spread of diseases to man via aquatic organisms multiplying in excreta-laden water needs special attention.R21;1269 [1501] Much of that attention has focused on influenza.1270 [1502] R20;The ducks, the ducks, the ducks are the key to the whole damned thing,R21; Webster once exclaimed to a Newsday reporter.1271 [1503] Due to the growing industrialization and pollution of migratory aquatic flyways, wild ducks are landing in increasing numbers on these farmed fish ponds.1272 [1504] The influenza virus found naturally and harmlessly in ducksR17; intestines are excreted in the water. The chickens may drink the virus-laden water. The pigs then eat the virus-laden chicken feces. The ducks then drink the pond water contaminated by the virus-laden pig excrement and the cycle can continue. The pond water ends up a R20;complete soupR21; of viruses, admits the head of the Hong Kong environmental think tank Civic Exchange.1273 [1505] Dead ducks or chickens may also be fed to pigs, providing another potential route of infection. This risky practice is not limited to Asia. In the H5N2 outbreak in the United States in the 1980s, pigs raised under chicken houses in Pennsylvania and fed dead birds came down with the infection as well.1274 [1506] Integrating pigs and aquaculture affords this waterborne duck virus a rather unique opportunity to cycle through a mammalian species, accumulating mutations that may better enable it to adapt to mammalian physiology. Migratory ducks could then theoretically fly the mutant virus thousands of miles to distribute it to other ponds, pigs, and ducks across the continent. Although there is concern that the virus could infiltrate the abdominal fluid or even the muscle meat of the farmed fish,1275 [1507] the aquatic animals are largely thought to be innocent bystanders.1276 [1508] Without the Trojan duck vectors, fish farming wouldnR17;t pose a pandemic threat. Likewise, without the pigs, the fish farms would be no riskier than the thousands of Canadian lakes where ducks congregate and discharge virus into the water every summer. Any spoonful of lake water from this R20;veritable witchesR17; brew of avian influenzaR21; (as Webster puts it) may contain virus, but as long as it stays between ducks, as it has for millions of years up until domestication, it poses no pandemic threat.1277 [1509] The aquaculture industry disagrees that its practices are potentially hazardous.1278 [1510] Indeed, one review noted that R20;enormous differences of opinion exist between epidemiologists and aquaculturists.R21;1279 [1511] Fish farming advocates argue that integrated aquaculture is R20;uncommon.R21;1280 [1512] One aquaculture professor estimates that, at most, only 20% of pigs in China are involved in aquaculture production.1281 [1513] However, 20% is 100 million pigs, plenty of fodder for viruses to potentially extract adaptive pearls from swine.1282 [1514] An industry insider admitted that aquaculturists have too often adopted a R20;bury-your-head-in-the-sandR21; attitude when it comes to human disease threats.1283 [1515] While fish farmers continue to downplay the risks, medical historians speculate that integrated aquaculture may have played a role in the increasing threat of pandemic influenza.1284 [1516] R20;As these agricultural practices increase,R21; wrote one commentator in the journal Science, R20;so does the likelihood that new potentially lethal influenza viruses will increase at the same time.R21;1285 [1517] (c) BirdFluBook.com | Home [1518] | Website by Lantern Media [1519] Bird Flu - Hog Ties BirdFluBook.com [1520] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1521] Hog Ties Before the 1997 outbreak of H5N1 and the realization that the 1918 virus was also purely avian in origin, pigs were thought to be the prime R20;mixing vesselsR21; by which human and avian influenza viruses could potentially mix and match their genes to create strains capable of infecting humans. All influenza viruses use cellular sialic acid receptors to dock onto cells and infect them. The sialic acid receptors lining the intestines of ducks have what are called alpha-2,3 linkages, whereas human lungs have sialic acid receptors with alpha-2,6 linkages. Influenza strains tend only to bind effectively with one type of receptor or the other. This difference in receptor compatibility helps form a species barrier, keeping the bird strains in the birds and the human strains in the humans.1286 [1522] How then, could a hybrid bird-human virus ever arise? Researchers discovered that the respiratory tracts of pigs have both types of molecular linkages. Since pigs display both bird-type and human-type virus receptors, pigs could potentially be simultaneously infected with both bird flu and human flu. With both viruses slobbering throughout the pigsR17; respiratory systems, the strains might re-assort to create a hybrid virus that could recognize human-type receptors but retain enough avian novelty to escape pre-existing human immunity. This could theoretically trigger mild pandemics as were seen in 1957 and 1968,1287 [1523] thought to be mild because humans retained at least some immune memory to the human fraction of the hybrid virus. There is building evidence that this scenario may be more than just speculation; pigs may indeed play some role in avian influenzaR17;s adaptation to people. During the 1918 pandemic, millions of pigs fell ill. The question at the time was did they give it to us or did we give it to them?1288 [1524] Our current understanding of the chain of events was that the 1918 pandemic H1N1 virus started, as we presume it always does, in waterfowl spread to domesticated poultry. It then spread to humans and dead-ended in pigs.1289 [1525] Since then, the H1N1 virus has circulated in pig populations, becoming one of the most common causes of respiratory disease on North American pig farms.1290 [1526] Then something strange started to happen in 1998. Throughout the century, influenza viruses had established a stable H1N1 lineage in U.S. pigs. But in August 1998, a barking cough resounded throughout a North Carolina pig farm in which all the thousands of breeding sows fell ill. An aggressive H3N2 virus was discovered, the type of influenza that had been circulating in humans since 1968. Not only was this highly unusualR12;only a single strain of human virus had ever previously been isolated from an American pig populationR12;but upon sequencing of the viral genome, researchers found that it was not just a double reassortment (a hybrid of human and pig virus, for example) but a never-before-described1291 [1527] triple reassortment, a hybrid of three virusesR12;a human virus, a pig virus, and a bird virus. R20;Within the swine population, we now have a mammalian-adapted virus that is extremely promiscuous,R21; explains one molecular virologist, referring to the virusR17;s proclivity to continue to snatch up genes from human flu viruses. R20;We could end up with a dangerous virus.R21;1292 [1528] Within months, the virus showed up in Texas, Minnesota, and Iowa.1293 [1529] Within a year, it had spread across the United States.1294 [1530] Pigs did not begin to fly. The rapid dissemination across the country was blamed on long-distance live animal transport.1295 [1531] In the United States, pigs travel coast to coast. They can be bred in North Carolina, fattened in the corn belt of Iowa, and slaughtered in California.1296 [1532] While this may reduce short-term costs for the pork industry, the highly contagious nature of diseases like influenza (perhaps made further infectious by the stresses of transport)1297 [1533] needs to be considered when calculating the true cost of long-distance live animal transport. What led to the emergence of this strain in the first place? What changed in the years leading up to 1998 that facilitated the surfacing of such a unique strain? It is likely no coincidence that the virus emerged in boss hog North Carolina, the home of the nationR17;s largest pig farm.1298 [1534] North Carolina has the densest pig population in North America and boasts more than twice as many corporate swine mega-factories as any other state.1299 [1535] The year of emergence, 1998, was the year North CarolinaR17;s pig population hit ten million, up from two million just six years before.1300 [1536] At the same time, the number of hog farms was decreasing, from 15,000 in 1986 to 3,600 in 2000.1301 [1537] How do five times more animals fit on almost five times fewer farms? By cramming about 25 times more pigs into each operation. In the 1980s, more than 85% of all North Carolina pig farms had fewer than 100 animals. By the end of the 1990s, operations confining more than 1,000 animals controlled about 99% of the stateR17;s inventory.1302 [1538] Given that the primary route of swine flu transmission is thought to be the same as human fluR12;via droplets or aerosols of infected nasal secretions1303 [1539] R12;itR17;s no wonder experts blame overcrowding for the emergence of new flu virus mutants. Starting in the early 1990s, the U.S. pig industry restructured itself after TysonR17;s profitable poultry model of massive industrial-sized units.1304 [1540] As a headline in the trade journal National Hog Farmer announced, R20;Overcrowding Pigs PaysR12;If ItR17;s Managed Properly.R21;1305 [1541] The majority of U.S. pig farms now confine more than 5,000 animals each. A veterinary pathologist from the University of Minnesota stated the obvious in Science: R20;With a group of 5,000 animals, if a novel virus shows up it will have more opportunity to replicate and potentially spread than in a group of 100 pigs on a small farm.R21;1306 [1542] Europe is facing a similar situation.1307 [1543] Virginia-based Smithfield is the largest pork producer in the world, raking in more than $10 billion in annual revenue and posting record profits in 2005, in part because of its expansion of factory-sized pig farms in Europe.1308 [1544] This trend is raising a stink among both environmentalists1309 [1545] and public health officials.1310 [1546] By 1993, a bird flu virus had adapted to pigs, grabbed a few human flu virus genes, and infected two young Dutch children, even displaying evidence of limited human-to-human transmission.1311 [1547] Denmark is the North Carolina of Europe. In 1970, the number of pig farms with more than 500 animals was zero. Between 1980 and 1994, 70% of the pig farms went out of business at the same time the pig population climbed to more than ten million.1312 [1548] Today, this tiny country is the largest exporter of pork in the world.1313 [1549] The worldR17;s bans on Asian poultry because of bird flu, combined with bans on U.S. beef because of mad cow disease, are, according to the chairman of DenmarkR17;s Bacon and Meat Council, R20;beginning to favourably affect demand.R21;1314 [1550] R20;Influenza [in pigs] is closely correlated with pig density,R21; said a European Commission-funded researcher studying the situation in Europe.1315 [1551] As such, EuropeR17;s rapidly intensifying pig industry has been described in Science as R20;a recipe for disaster.R21;1316 [1552] Some researchers have speculated that the next pandemic could arise out of R20;EuropeR17;s crowded pig barns.R21;1317 [1553] The European CommissionR17;s agricultural directorate warns that the R20;concentration of production is giving rise to an increasing risk of disease epidemics.R21;1318 [1554] Concern over epidemic disease is so great that Danish laws have capped the number of pigs per farm and put a ceiling on the total number of pigs allowed to be raised in the country.1319 [1555] No such limit exists in the United States. Complicating the U.S. picture, the new swine viruses appear to be crossing back to commercial poultry, as reported in the CDC journal Emerging Infectious Diseases. The investigators warn: R20;Repeated introductions of swine influenza viruses to turkeys, which may be co-infected with avian influenza viruses, provide opportunities for the emergence of novel reassortments with genes adapted for replication in pigs or even humans.R21;1320 [1556] North Carolina is also a top poultry producer. Webster blames the triple assortment of the 1998 virus on the R20;recently evolving intensive farming practice in the USA, of raising pigs and poultry in adjacent sheds with the same staff,R21; a practice he calls R20;unsound.R21;1321 [1557] With massive concentrations of farm animals within which to mutate, these new swine flu viruses in north America seem to be on an evolutionary fast track, jumping and reassorting between species at an unprecedented rate.1322 [1558] In 2006, the pig/bird/human triple reassortment strain was isolated from a farm worker in Canada.3175 [1559] This reassorting, WebsterR17;s team concludes, makes the 60 million strong1323 [1560] U.S. pig population an R20;increasingly important reservoir of viruses with human pandemic potential.R21;1324 [1561] R20;We used to think that the only important source of genetic change in swine influenza was in Southeast Asia,R21; says a molecular virologist at the University of Wisconsin. Now, after H5N1, R20;we need to look in our own backyard for where the next pandemic may appear.R21;1325 [1562] There have been about a hundred documented human deaths from swine flu in the last 30 years,1326 [1563] including a young pregnant woman in the United States in 1988.1327 [1564] On day 1, she visited a county fair in Wisconsin. On day 4, she started exhibiting signs of the flu. On day 11, she was hospitalized and intubated on a ventilator for respiratory failure. On day 14, labor was induced and she gave birth to a healthy baby. On day 18, she died. CDC laboratory analysis showed she was killed by a swine flu virus that she presumably contracted at the agriculture fair.1328 [1565] H5N1 and the virus of 1918 help argue, however, that pigs may not be needed to produce killer viruses with pandemic potential.1329 [1566] It turns out that the human respiratory tract, like the pig respiratory tract, has bird flu-type receptors after all, eliminating the need for an intermediate porcine host.1330 [1567] Human beings can be directly infected with bird flu. Sufficiently adapted for efficient human-to-human transmission, a wholly avian virus could potentially infect billions since there may be no prior immunity in humans. In this way, H5N1 has been said to be following in the 1918 virusR17;s footsteps,1331 [1568] though in actuality the footprints, so to speak, have since been weathered away.1332 [1569] Instead of reassorting to form hybrids in some sort of transitional species mixing vessel, H5N1 is directly attacking the human species, as the 1918 virus is presumed to have done, via an R20;adaptation of a smoldering avian progenitor.R21;1333 [1570] The head of the American Public Health Association conjectured, R20;This organism is following the historical [pandemic] playbook step by step.R21;1334 [1571] That avian progenitor may have acquired some mammalian adaptive traits cycling through pigs on aquaculture farms or wallowing though flooded rice fields awash with domestic ducks,1335 [1572] but there is still a vast gulf between a harmless waterborne intestinal duck virus and a killer airborne respiratory human virus. The influenza virus has the mutation machinery to bridge that gap, but it needs a lot of test tubes. Although pork is the most popular meat in the world,1336 [1573] the biggest piggeries still only may contain tens of thousands of animals.1337 [1574] The biggest egg farms confine more than a million.1338 [1575] It may take six months for a piglet to reach slaughter weight, but much of the global broiler chicken population is hatched and killed in as few as six weeks, dramatically multiplying the annual number of new viral hosts. More than 45 billion chickens pass through the world every year, compared to only about 1 billion pigs. Spread wing to wing, the number of chickens killed every day would wrap more than twice around the worldR17;s equator.1339 [1576] Never before has the influenza virus had such an opportunity. (c) BirdFluBook.com | Home [1577] | Website by Lantern Media [1578] Bird Flu - Viral Swap Meets BirdFluBook.com [1579] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1580] Viral Swap Meets To take advantage of this feathered bounty, the H5N1 virus first had to find a way out from the guts of waterfowl. How did the Guangdong goose H5 ever find the duck N1 in quail? How did the goose-duck H5N1 hybrid find its way from quail to Hong Kong chickens? And how did the virus spread from farm to farm? Although some have proposed live poultry delivery trucks improperly cleaned between separate hauls of different bird species as the culprit, the more likely explanation may be cross-contamination at live bird markets.1340 [1581] Professor Kennedy Shortridge, the virologist who first characterized H5N1 in Asia, may have predicted its site of emergence years before its appearance. In 1992, he urged surveillance in R20;Hong Kong, as the place with the most extensive contact with China and a possible place of exit of an emerging pandemic virus.R21;1341 [1582] What is it about China that makes it such a hotbed of influenza virus activity? Shortridge blames the R20;great diversity of influenza viruses in the duck population in this regionR21;R12;a function, in large part, of R20;the mass production of ducks for human consumptionR30;.R21;1342 [1583] For centuries, Guangdong province has had the largest concentration of poultry, pigs, and people in the world.1343 [1584] The R20;Asian fluR21; of 1957 and the R20;Hong Kong fluR21; of 1968 are just the latest two examples of pandemics arising in the region. Historical records dating back centuries link emerging influenza epidemics and pandemics to this area of the world, although the first pandemic for which we have cogent data was the one that preceded 1918 in 1889.1344 [1585] Guangdong surrounds and feeds Hong Kong, one of the most heavily populated areas in the world: The cityR17;s seven million people1345 [1586] are packed into densities exceeding 50,000 people per square mile in some areas.1346 [1587] A survey of nearly a thousand Hong Kong households1347 [1588] found that 78% prefer R20;warmR21; meat.1348 [1589] One hundred thousand chickens stream into Hong Kong everyday from Guangdong1349 [1590] to be sold alive in more than a thousand retail markets, stalls, and shops.1350 [1591] As one influenza expert quipped, R20;Hong Kong is one big bird market.R21;1351 [1592] This preference for just-killed poultry provides what Shortridge calls an R20;avian influenza virus melting pot.R21;1352 [1593] Chickens and ducks, geese and quail are crammed into small plastic cages stacked as much as five high in these live animal R20;wetR21; markets. Distressed birds defecate on those below them.1353 [1594] Feathers and feces are everywhere.1354 [1595] So are blood and intestines.1355 [1596] According to the World Health Organization, the birds are often slaughtered on the spot, R20;normally with very little regard for hygiene.R21;1356 [1597] R20;The activities of humans have affected the evolution of influenza,R21; reads a 2004 Cambridge University Press textbook on pathogen evolution, R20;but not to our advantage. Close confinement of various strains of fowl in live poultry markets provide conditions ripe for the formation of new reassortment viruses and their transmission to humans.R21;1357 [1598] If live animal markets turned a cold virus into a killer in the case of SARS, it may help turn a flu virus into a mass killer. According to the Hong Kong survey, householders buy an estimated 38 million live chickens every year, generating millions of human-chicken contacts.1358 [1599] R20;They touch the neck and blow on the other end to see how good it is,R21; one Hong Kong microbiologist explained, holding up and turning his hands as if looking at the birdR17;s posterior.1359 [1600] According to the University of Hong Kong School of Public Health, vendors and consumers are inevitably contaminated with fecal dust at these markets.1360 [1601] Scientists were not surprised, then, that H5N1 surfaced first in Hong Kong.1361 [1602] Birds who remain unsold at the end of the day may go back to the farms of Guangdong, taking whatever new viruses they picked up with them.1362 [1603] Webster and colleague D. J. Hulse wrote, R20;Highly concentrated poultry and pig farming, in conjunction with traditional live animal or R16;wetR17; markets, provide optimal conditions for increased mutation, reassortment and recombination of influenza viruses.R21;1363 [1604] Once the cycle has been sufficiently repeated, a virus can then use Hong Kong to escape. As the travel and commercial hub of Pacific Asia, Hong Kong represents a viral portal between the intensive farms of rural China and the human populations of the world.1364 [1605] In response to the emergence of H5N1, the government of Hong Kong has tried separating different species and ordered all duck and geese intestines packed when being sold in live chicken stalls to reduce cross-contamination. Over the long term, the UN Food and Agriculture Organization has asked Hong Kong to move toward centralized slaughter facilities, a touchy subject with political as well as economic implications.1365 [1606] Paul Chan, a professor of microbiology at Chinese University of Hong Kong agrees, R20;I support doing away with selling live poultry altogether.R21;1366 [1607] Even if all Hong Kong live markets were closed, argues Webster, this would be unlikely to reduce the overall pandemic risk unless live markets could be closed throughout China and elsewhere.1367 [1608] The China Wildlife Conservation Association estimates that within Guangdong province itself, several thousands of tons of wild birds are consumed in special stores each year, where they may mix with farmed birds before they are slaughtered for food.1368 [1609] Bird markets outside of Hong Kong may be subject to even less regulation and are likely accompanied by less intensive surveillance for disease as well.1369 [1610] China has set the precedent, however, of attempting1370 [1611] to ban all live bird markets in Shanghai, its largest city, as well as the capital city of Beijing.1371 [1612] Hong Kong has also finally decided to phase them out,1372 [1613] and the Chinese government has reportedly urged all big cities to R20;gradually call off the killing and sales of live fowls in the market.R21;3177 [1614] . Similarly bans have reportedly been proposed in Singapore, Bangkok,3178 [1615] Japan3179 [1616] and VietnamR17;s Hanoi, Hai Phong, Vinh and Ho Chi Minh City.3180 [1617] R20;Until the traditional practice of selling poultry in the live market changes,R21; concludes WebsterR17;s team, R20;we will have to accept that live markets are breeding grounds for influenza virusesR30;.R21;1373 [1618] These breeding grounds are not limited to Asia.1374 [1619] We shouldnR17;t forget that before H5N1, the biggest outbreak of bird flu in history wasnR17;t in China; it was in Pennsylvania. In the 1980s, the United States suffered the most costly and extensive disease eradication in its history, the outbreak of H5N2 that led to the deaths of 17 million chickens at a cost to taxpayers and consumers exceeding $400 million.1375 [1620] The outbreak may have been linked to live bird markets in the northeastern United States.1376 [1621] Before then, highly pathogenic bird flu had struck in the 1920s and later occurred in Texas in 2004. Both of these other high-grade bird flu incidents,1377 [1622] ,1378 [1623] as well as most of the latest U.S. discoveries of low-grade viruses, have also been tentatively linked to U.S. live poultry markets.1379 [1624] The USDA estimates more than 20 million birds of different species pass through 150 known storefront live bird markets just in northeast metropolitan areas every year.1380 [1625] Unlike Hong Kong, which learned its lesson and now segregates waterfowl from terrestrial species, U.S. ducks and chickens are still crammed on top of one another.1381 [1626] As in Hong Kong markets, cages are generally stacked four to five tiers high, ensuring plenty of fecal splatter from distressed birds.1382 [1627] R20;If you have seen these markets, you know that the birds are under stressful conditions,R21; said a veterinarian with New YorkR17;s Department of Agriculture. R20;And birds under stress are much more prone to disease.R21;1383 [1628] Though suspected to play a pivotal role in the spread of bird flu in the United States,1384 [1629] the problem seems to be worsening. In New York City, for example, the number of live bird markets almost doubled from 44 in 1994 to more than 80 in 2002.1385 [1630] Given the risk, many in the U.S. commercial poultry industry are R20;absolutely determinedR21; to have live markets eliminated, according to a Louisiana State University poultry scientist.1386 [1631] Briefly but incisively, the president of the USA Poultry and Egg Export Council commented, R20;We canR17;t jeopardize the entire U.S. [poultry] industry.R21;1387 [1632] The USDA agrees that live bird markets have been shown to present a R20;major riskR21; to the nationR17;s poultry industry.1388 [1633] USDA scientists write, R20;The live bird markets of the Northeast remain the biggest concern for the presence of avian influenza in the United States.R21;1389 [1634] If both the industry and the USDA agree (as they tend to do), why have live bird markets persisted and indeed been allowed to flourish? Some industry officials fear that closing bird markets would drive the entire trade underground, making it even more difficult to regulate.1390 [1635] After SARS, for example, customer demand in Asia drove the cost of civet cats up to $200, making it likely that such animals could be obtained regardless of legality.1391 [1636] The USDA has therefore chosen to R20;manage or mitigate the risk rather than to outlaw it.R21;1392 [1637] By its own admission, the USDA is doing a poor job of risk management. Speaking at the Fifth International Symposium on Avian Influenza in 2002, USDA poultry researchers said, R20;Considerable efforts are continuing on the part of industry and state and federal governments to control influenza in the LBM [live bird market] system, but currently the efforts have been unsuccessful.R21;1393 [1638] R20;Despite educational efforts, surveillance, and increased state regulatory efforts,R21; the USDA admitted the following year that R20;the number of [bird flu] positive markets has persisted and increased.R21;1394 [1639] Live bird markets seem inherently risky. In response to virus isolations from New JerseyR17;s markets, the State Veterinarian said, R20;They can be doing everything right and still have a market that tests positive.R21;1395 [1640] Despite risk mitigation efforts, experts at USDA and the University of Georgia concluded in a 2006 review that U.S. live bird markets remain R20;an ideal environment for transmission, adaptation and evolution of avian influenza viruses.R21;3176 [1641] Even if a segment of the live bird trade was forced underground, it might not get much worse. Record-keeping in live poultry markets is already sparse or nonexistent even as to the birdsR17; countries of origin.1396 [1642] Currently, the purchase and sale of live birds is a cash business in which market owners are R20;disinclined to keep accurate records that would be costly if subjected to IRS scrutiny.R21;1397 [1643] A 2003 survey of handling practices at live bird markets found that fewer than 2% of suppliers followed the recommended biosecurity practices to prevent the spread of the disease.1398 [1644] USDA Science Hall of Famer1399 [1645] Charles Beard is concerned that U.S. live bird markets could be the portal by which H5N1 enters commercial poultry flocks in the United States.1400 [1646] Live bird markets continue to exist in the United States only because local health authorities continue to license them. They are exempt from federal meat inspection laws because they slaughter fewer than 20,000 birds a year,1401 [1647] an exemption that doesnR17;t apply for other animals.1402 [1648] Poultry specialists predict that if live bird markets had to be held to the same federal standards of inspection, cleanliness, and pathogen control as the commercial poultry industry, or small producers of other animals, R20;authorities could virtually eliminate LBMs.R21;1403 [1649] The University of Hong Kong School of Public Health laid out the pros and cons: R20;The trade-off between the preference for eating the flesh of freshly slaughtered chicken and the risk to local, regional, and global population health from avian influenza should be addressed directly, and in terms of a precautionary public health approach aimed at providing the greatest benefit to the maximum possible number of people.R21;1404 [1650] Robert Webster, considered the worldR17;s authority on avian influenza, concludes a landmark article on the emergence of pandemic strains of influenza with these words: R20;An immediate practical approach is to close all live poultry marketsR30;.R21; He goes on to note that with refrigeration systems widely availableR12;even through much of the developing worldR12;it is no longer necessary to sell live or just-slaughtered birds. R20;The reality is that traditions change very slowly,R21; he said, but R20;a new pandemic could accelerate this process.R21;1405 [1651] (c) BirdFluBook.com | Home [1652] | Website by Lantern Media [1653] Bird Flu - Gambling with Our Lives? BirdFluBook.com [1654] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1655] Gambling with Our Lives? Cockfighter tending to wounds The explosion of H5N1 in early 2004, which led to the deaths of more than 100 million chickens across eight countries in Southeast Asia, was traced to the trade in live birds.1406 [1656] The timing and pattern were inconsistent with known migratory bird routes.1407 [1657] The initial spread of this disease seems to have been via the railways1408 [1658] and highways, not the flyways.1409 [1659] The riskiest segment of trade may be in fighting cocks, transported across borders to be unwilling participants in the high-stakes gambling blood R20;sport.R21;1410 [1660] In cockfighting pits, roosters are set upon one another, often pumped full of steroids and stimulants, with sharpened razors strapped to their legs. The sprays of bloody droplets help ensure that any virus present travels back home after the fights in newly infected birdsR12;or people. A number of cockfighting enthusiasts, and children of cockfighters,1411 [1661] have died from H5N1.1412 [1662] The Thai Department of Disease Control described a case of a young man who had R20;very close contact toR30;fighting cocks by carrying and helping to clear up the mucus secretion from the throat of the cock during the fighting game by using his mouth.R21; As one leading epidemiologist at the CDC commented dryly, R20;That was a risk factor for avian flu we hadnR17;t really considered before.R21;1413 [1663] The movement of gaming cocks was directly implicated in the rapid spread of H5N1. Malaysian government officials blamed cockfighters as the main R20;culpritsR21; for bringing the disease into their country by taking birds to cockfighting competitions in Thailand and bringing them back infected.1414 [1664] Thailand, with an estimated 15 million fighting cocks,1415 [1665] was eventually forced to pass a nationwide interim ban on cockfighting.1416 [1666] The director of Animal Movement Control and Quarantine within the Thai Department of Livestock Development explained what led to the ban: R20;When one province that banned cockfights didnR17;t have a second wave outbreak of bird flu and an adjacent province did, it reinforced the belief that the cocks spread disease.R21;1417 [1667] A study of Thailand published in 2006 concluded, R20;We found significant associations at the national level between HPAI [H5N1] and the overall number of cocks used in cock fights.R21;1418 [1668] According to the FAO, cockfighting may have also played a role in making the disease so difficult to control.1419 [1669] During mass culls in Thailand, bird owners receive around 50 baht, about $1.25, in compensation for each chicken killedR12;less than the birdR17;s market value for meat.1420 [1670] Some prized fighting cocks fetch $1,000, providing a disincentive for owners to report sick birds.1421 [1671] Fighting cocks were reportedly hidden from authorities and illegally smuggled across provincial lines and country borders. This not only complicated the attempt at eradicating of H5N1, but potentially facilitated its spread,1422 [1672] causing some officials to throw up their hands. R20;Controlling the epidemic in the capital is now beyond the ministryR17;s competence,R21; ThailandR17;s Deputy Agriculture Minister told the Bangkok Post, R20;due to strong opposition from owners of fighting cocks, who keep hiding their birds away from livestock officials.R21;1423 [1673] The Los Angeles Times likened asking Thais to give up cockfighting to R20;asking Americans to abandon baseball.R21;1424 [1674] A different poultry virus, the cause of exotic Newcastle disease, did hit a home run in California, thanks to U.S. cockfighters. Cockfighting is illegal in 48 states in the United States, carrying felony charges in most of them. Cockfighting rings have found relative refuge, however, in some states like California that retain only misdemeanor penalties.1425 [1675] In 2002, an outbreak of Newcastle disease in California caused the destruction of nearly four million chickens at a cost to taxpayers of upwards of $200 million1426 [1676] and led to a multinational boycott of U.S. poultry products.1427 [1677] Fighting roosters smuggled in from Mexico were blamed for its emergence,1428 [1678] and, according to the State Veterinarian and the director of Animal Health and Food Services in California, the high mobility of the gamecocksR12;meetings, training, breeding, and fighting activitiesR12;played a major role in the spread of the disease.1429 [1679] Although agriculture inspectors could not pinpoint the exact route by which the disease then jumped to Las Vegas and into Arizona, law enforcement had an idea. R20;WeR17;ll raid a fight in Merced County and find people from Nevada, New Mexico, Mexico, Arizona, and Southern California,R21; said a detective with the Merced County SheriffR17;s office. R20;They bring birds to fight and take the survivors home.R21;1430 [1680] Cockfighting also played a role in a prior exotic Newcastle disease outbreak in California, which led to the deaths of 12 million chickens.1431 [1681] Although Newcastle can be fatal to nearly all species of birds, it does not represent a significant health risk to humans.1432 [1682] R20;Fighting cocks were responsible for the spread of Newcastle disease in USA,R21; warns the company veterinarian of the worldR17;s leading poultry breeding corporation,1433 [1683] R20;but equally the virus could have been Avian Influenza.R21;1434 [1684] An article in The Gamecock openly encourages U.S. breeders of fighting cocks to hide birds from health inspection authorities should bird flu arrive in the States.1435 [1685] R20;DonR17;t be surprised,R21; said U.S. Representative and senior member of the Permanent Select Committee on Intelligence Elton Gallegly, R20;if the deadly avian flu enters the United States in the blood of a rooster smuggled into the country for the barbaric sport of cockfighting.R21;1436 [1686] During the course of containment following the 2002 outbreak, agriculture officials were staggered by the number of illegal cockfighting operations they stumbled uponR12;up to 50,000 gamecock operations in southern California alone, according to some estimates.1437 [1687] Despite being illegal for more than a century1438 [1688] and despite hundreds of arrests,1439 [1689] state law enforcement officials say that cockfighting continues to grow in popularity.1440 [1690] One University of California, Davis, poultry specialist told the Los Angeles Times recently, R20;In Los Angeles, IR17;m confident you could find far more than 10 fights this weekend.R21;1441 [1691] According to the cockfightersR17; trade association, the American Animal Husbandry Coalition, there are thousands of operations that raise fighting cocks across the country.1442 [1692] In states where raising birds for blood sports is illegal, breeders claim the cocks are being raised as pets1443 [1693] or for show.1444 [1694] A 2005 FBI raid breaking up a cockfighting ring in Tennessee discovered participants from half a dozen states.1445 [1695] In May 2006, California customs officials jailed two individuals allegedly smuggling fighting roosters over the border.1446 [1696] With American roosters participating in competitions in Asia, like the 2006 World Slasher Cup,1447 [1697] itR17;s clear that birds are being shipped illegally around the world.1448 [1698] All it may take is one contraband avian Typhoid Mary smuggled from Asia into some clandestine U.S. cockfight to potentially spread bird flu throughout the United States. Strengthening penalties and improving enforcement on interstate transport of fighting cocks in America, as well as putting the final two nails in the cockfighting coffin by banning the practice in Louisiana and New MexicoR12;the last two states that still legally allow cockfightingR12;may help protect the health of AmericaR17;s flocks and AmericaR17;s people.1449 [1699] The National Chicken Council, the trade association for the U.S. commercial poultry industry, agrees. The NCC damns cockfighting as not only R20;inhumane,R21; but as posing a R20;serious and constant threat of disease transmission to the commercial industry.R21;1450 [1700] A spokesperson for the United Gamefowl Breeders Association cries foul at the notion that cockfighting is inhumane, arguing that birds donR17;t feel pain.1451 [1701] When the president of the National Chicken Council wrote to the chair of the House Agriculture Committee saying, R20;We are concerned that the nationwide traffic in game birds creates a continuing hazard for the dissemination of animal diseases,R21; the president of the United Gamefowl Breeders Association responded, R20;You blatantly attack our industryR30;[but] it is the commercial poultry industry that has threatened the livelihood of other birds by transporting poultry that can release airborne pathogens (e.g. feathers being released) through the open-side transportation methods used on U.S. highways.R21;1452 [1702] HeR17;s got a point. The Food and Agriculture Organization of the United Nations blames the transport of live birds raised for human consumption as a primary culprit in the rapid spread of avian influenza throughout Asia.1453 [1703] One senior Thai public health officer told a New Yorker reporter, R20;Chickens used to live in our backyards. They didnR17;t travel much. Now, throughout the world, farms have become factories. Millions of chickens are shipped huge distances every day. We canR17;t stop every chicken or duck or pig. And they offer millions of opportunities for pathogens to find a niche.R21;1454 [1704] Trucking live poultry has also been implicated in the spread of the disease in Europe.1455 [1705] An FAO consultancy report on the genesis and spread of H5N1 concluded that a R20;longer term prevention measure would be to reduce local and international supply-demand discrepancies such as to reduce the local and long-distance trade.R21;1456 [1706] In the United States, live birds are even shipped in boxes via the U.S. Postal Service.1457 [1707] In August 2005, the North Carolina Department of Agriculture Food and Drug Safety administrator told a gathering of federal and state officials that current U.S. Postal Service regulations R20;are inadequate and present great potential for contamination of the poultry industry.R21;1458 [1708] He estimates that each year, thousands of fighting cocks and other birds lacking health certificates enter North Carolina, potentially placing the stateR17;s massive1459 [1709] poultry industry at risk.1460 [1710] R20;Chickens find transport a fearful, stressful, injurious and even fatal procedure,R21; one group of expert researchers concluded.1461 [1711] This high level of stress has been shown to make birdsR12;whether raised for fighting, food, or any other useR12;more susceptible to spreading disease.1462 [1712] The legal and illegal international trade in fighting cocks makes the blood sport no safe betR12;in fact, the stakes may be higher than anyone imagined. (c) BirdFluBook.com | Home [1713] | Website by Lantern Media [1714] Bird Flu - Stopping Traffic BirdFluBook.com [1715] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1716] Stopping Traffic H5N1-infected smuggled eagles Fighting cocks are not the only birds smuggled internationally. Wild birds are sold by the millions as part of the global pet trade. Before H5N1, a single market in Indonesia sold up to 1.5 million wild birds every year.1463 [1717] With the development of electronic payment methods over the internet, the international trafficking of wild animals has surgedR12;up more than 60% in the United States, for example, over the past decade.1464 [1718] The U.S. Fish and Wildlife Service estimates that Americans have imported more than 350,000 birds a year.1465 [1719] Although imports of all birds from countries with documented H5N1 poultry outbreaks have been banned jointly by the CDC and the USDA,1466 [1720] the combination of a thriving black market,1467 [1721] lax laws in Southeast Asia,1468 [1722] and the rapid spread of the disease to new counties1469 [1723] threatens to turn the legal U.S. trade in pet birds into a cover for the laundering of smuggled Asian birds into the United States. R20;ItR17;s big business,R21; said a spokesperson for the U.S. Fish and Wildlife Service about the illegal smuggling of exotic birds, ranking it just behind drug smuggling as border controlR17;s chief law enforcement concern.1470 [1724] The U.S. State Department estimates that the illegal exotic animal trade is a $10 billion industry.1471 [1725] Many birds are illicitly imported from Asian countries battling bird flu.1472 [1726] R20;We are genuinely concerned,R21; said the administrator of USDAR17;s Animal and Plant Health Inspection Service about the risk of smuggled birds bringing H5N1 to U.S. shores.1473 [1727] The risk is not theoretical. In late 2004, a man from Thailand was stopped for a routine random drug check in a Belgian airport. Authorities found a pair of rare crested hawk eagles stuffed into plastic tubes in his luggage.1474 [1728] Both of the birds were found to be harboring H5N1.1475 [1729] The report of the incident in the CDCR17;s Emerging Infectious Diseases journal concluded: R20;[I]nternational air travel and smuggling represent major threats for introducing and disseminating H5N1 virus worldwide.R21;1476 [1730] R20;We were very, very lucky,R21; said the chief influenza expert at BelgiumR17;s Scientific Institute of Public Health. R20;It could have been a bomb for Europe.R21;1477 [1731] Bird smuggling may actually have been what brought the West Nile virus to the Western Hemisphere.1478 [1732] West Nile hit New York in 1999 and has since spread across 48 states and Canada,1479 [1733] with thousands of cases in 2005 and more than 100 deaths.1480 [1734] Its continued expansion suggests that the virus has become permanently established in the United States, all, perhaps, because of a single illegally imported pet bird.1481 [1735] The United Nations#8217; FAO describes even the legal trade in wild birds as a R20;serious potential opportunity for new [bird flu] disease transmission.R21;1482 [1736] Wild birds come from jungles around the world, trapped by nets or glue smeared on branches. Traumatized by long hours confined in trucks and planes, as many as 75% die between capture and sale. Those who do live through the ordeal do so with compromised immune systems crammed into cages with multiple species in holding centers.1483 [1737] One former CDC lab director states: People who have seen the animal holding facilities at London-Heathrow, New York-Kennedy, and Amsterdam-Schiphol [airports] describe warehouses in which every type of bird and other exotic animals are kept cheek by jowl in conditions resembling those in Guangdong food markets, awaiting trans-shipment. There, poultry can come into close contact with wild-caught birds.1484 [1738] The USDA is coordinating with U.S. Customs and Border Control to increase vigilance for any movement of cargo or passengers coming from countries where there has been avian influenza H5N1.1485 [1739] Vigilance directed at imports from specific countries may provide a false sense of security, however, as traders have been successful in the past in concealing countries of origin by laundering the birds for export through unaffected countries. The case of the British parrot is a perfect example. In October 2005, the British government announced that H5N1 had been discovered in a parrot imported from South America. What is a South American bird doing with H5N1? The working hypothesis is that the bird contracted the virus while housed in a quarantine facility with birds from Taiwan who were also found to be infected.1486 [1740] But Taiwan, like South America, is supposedly free of bird flu. So what happened? That same month, a freighter was caught trying to smuggle into Taiwan from China more than a thousand birds, some of whom were infected with H5N1.1487 [1741] Perhaps infected birds were smuggled from China into Taiwan for global export, infecting the Taiwanese birds, who were then legally imported to the U.K. to mix with and infect the South American parrot.1488 [1742] The same thing could have happened in the United States, which imports more than 50,000 birds from Taiwan every year.1489 [1743] The president of the U.S. National Chicken Council claims that the American ban on imports from affected countries has effectively R20;locked, bolted and barred the door against anything that could conceivably be carrying the virus.R21;1490 [1744] Allowing the import of birds from any country, though, risks the introduction of birds smuggled into that country from a third, contaminated country. Similarly, waiting until H5N1 has been detected in a country to ban its imports may pose unnecessary risks. A complete ban on importation of birds for the pet trade, regardless of the supposed country of origin, would address this problem. This is the precautionary approach Europe took, passing an immediate interim ban on captive birds from all countries.1491 [1745] Such a measure would not be without precedent in the United States. After the 2003 Midwest monkeypox outbreak, the CDC and the FDA issued a joint emergency executive order prohibiting the importation of all African rodents into the United States.1492 [1746] This action was taken less than a month after the first confirmed case.1493 [1747] Given the much greater threat bird flu represents, suggestions to broaden the bird importation ban seem reasonable. Both the National Association of State Public Health Veterinarians and the Council of State and Territorial Epidemiologists have called for the federal ban to be expanded to outlaw the import and transport of all exotic wildlife to protect both human and animal health in America.1494 [1748] U.S. law requires that all birds imported from overseas undergo a 30-day quarantine,1495 [1749] a measure shown successful in catching a bird flu virus in Peking Robins imported from China years ago.1496 [1750] Birds smuggled illegally into the United States bypass this firewall. The legal trade in pet birds provides a cover for the illicit trade by providing market opportunities for smugglers to sell their birds. In addition to banning the importation of captive birds, closing down poorly regulated markets where birds are soldR12;flea market-like bird swaps and fairsR12;may further reduce the risk.1497 [1751] Asked about the possibility of smuggled birds transporting H5N1 into America, the USDAR17;s chief influenza scientist warned, R20;We should be more worried than we are.R21;1498 [1752] More than 200 non-governmental organizations representing millions of members have joined to urge a permanent ban on the importation of wild birds into the European Union.1499 [1753] The United States has yet to enact even a precautionary temporary ban. The pet bird industry claims that such a ban would have the opposite of the desired effect by driving trade underground and thereby increasing public health risk.1500 [1754] Not true, according to an agriculture minister who testifed before Parliament that the current EU ban on bird imports is having the desired effect and there is no evidence to suggest an increase in smuggling.1501 [1755] Historical evidence shows the same.1502 [1756] In 1992, the U.S. Wild Bird Conservation Act was passed to ban the importation of certain wild-caught birds in an attempt to save endangered species of birds from extinction. The pet industry made the same claims back then that illegal trade would increase, but the law worked as intended.1503 [1757] Scientists studying bird populations collectively reported that poaching of birds dropped significantly after passage of the law, and U.S. Customs testified that the number of birds smuggled over the border had dropped as well. Following the U.S. monkeypox outbreak, the infectious diseases edition of Lancet carried an editorial titled, R20;Trade in Animals: A Disaster Ignored,R21; which stressed the links between the trade in wild animals and disease. The editorial concluded: The practice of taking animals from the wild for the pet trade also should swiftly be brought to an end. There will be fierce opposition to any such moves, and some of the trade will move underground, but if we can abolish such entrenched cultural traditions as burning at the stake and slavery, we can abolish the clear danger to human health of the wildlife trade.1504 [1758] Global restrictions on the cockfighting and wild bird trades may play important roles in slowing the proliferation of H5N1, but now that the virus has infected migratory bird species, it may not need our help to spread.1505 [1759] The overlap of Asian and North American migratory bird paths in Alaska provide a theoretical flight risk for the virus to enter the western hemisphere as wellR12;outside of any cargo hold.1506 [1760] With the possibility of viruses with pandemic potential literally coming out of the blue, closing gaping slats in our picket-fence trade firewall may be merely stopgap measures. It wouldnR17;t matter how many species a bird flu virus infected in global live animal markets, or how widely the virus traveled by plane, truck, or duck, as long as it remained harmless as it had for millions of years.1507 [1761] What turned bird flu into a killer? (c) BirdFluBook.com | Home [1762] | Website by Lantern Media [1763] Bird Flu - Acute Life Strategy BirdFluBook.com [1764] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1765] Acute Life Strategy Understanding the ecology of the virus in its so-called R20;benign reservoirR21; is imperative if we hope to develop strategies to prevent future catastrophic outbreaks.1508 [1766] The primordial source of all influenza virusesR12;avian and mammalianR12;is aquatic birds.1509 [1767] In nature, the influenza virus has existed for millions of years as a harmless intestinal waterborne infection of waterfowl, particularly ducks.1510 [1768] The duck doesnR17;t get sick, because the virus doesnR17;t need to make the duck sick to spread. In fact, it may be in the virusR17;s best interest for the bird not to get sick so as to spread farther. Dead ducks donR17;t fly. The influenza gene pool is really more of a gene pond. Every year, untold numbers of wild ducks congregate on the worldR17;s lakes to mate, raise families, and spread the influenza virus to each other. The virus silently multiplies in the ducksR17; intestinal lining and is then excreted into the pond water to lie in wait for other ducks to touch down for a drink. The ducks gobble down the virus and the cycle continues. This had been going on for perhaps 100 million years before the first person came down with the flu.1511 [1769] Most ducks are infected as ducklings. Studies of ducks on Canadian lakes show that up to 30% of juvenile birds are actively shedding the virus.1512 [1770] The ducks excrete such massive titers of virus1513 [1771] that researchers have been able to culture it straight out of a spoonful of lake water.1514 [1772] Under the right conditions, the virus is estimated to be able to persist for years in cold water.1515 [1773] With such high concentrations of virus, with such highly efficient transmission,1516 [1774] and with such environmental stability, scientists estimate that virtually all of the millions of ducks in the world become infected sometime within their lives.1517 [1775] The ducks arenR17;t infected for long.1518 [1776] Most only shed virus for a few days, but the fecal-oral route of infection for aquatic birds is so efficient that this is thought to be enough to keep the virus spreading throughout the millennia.1519 [1777] Millions of years of evolution have so tailored the parasite to its host, a so-called R20;optimally adapted system,R21; that the virus seems completely innocuous to the ducks.1520 [1778] The virus exists in an R20;evolutionary stasisR21; in waterfowl,1521 [1779] remaining unchanged despite its furious mutation rate.1522 [1780] Influenza viruses donR17;t tend to retain any new mutations in ducks because they found their perfect niche. Sharks, for example, have remained basically unchanged for 100 million years, even while other species evolved around them, presumably because sharks had already evolved to be such perfected killing machines.1523 [1781] Similarly, evolution doesnR17;t seem to be able to much improve influenza. The virus continues to churn out millions of mutants in wild ducks in an attempt to spread faster and farther, but since the virus-duck relationship seems so flawlessly fine-tuned, any deviant viral progeny are less successful and die out. The virus has achieved peak efficiency and is found ubiquitously throughout aquatic bird species around the world.1524 [1782] Because the influenza virus in its natural state is so finely attuned to its aquatic host, it not only doesnR17;t harm the carrier duck, but it also seems unable to cause serious disease in people. There are only two reports of human infection from wild bird viruses in the medical literature. One case involved a woman who kept ducks and got a piece of straw caught in her eye while cleaning out her duck house,1525 [1783] and the second was a laboratory field worker whose eye was sneezed in by a bird flu-infected seal.1526 [1784] Despite direct inoculations of virus, the worst the virus seemed able to do was cause a mild, self-limited case of conjunctivitis, commonly known as pinkeye.1527 [1785] Duck flu viruses donR17;t seem to grow well in humans (or other primates), and human flu viruses donR17;t seem to grow well in ducks.1528 [1786] Scientists have even attempted to directly infect human volunteers with waterfowl viruses, but to little avail. Test subjects snorted massive doses of virusR12;enough to infect up to a billion birdsR12;yet most of the time the virus wouldnR17;t take hold at all, and when it had any effect, it typically produced nothing more than a transitory local reaction.1529 [1787] The evolutionary gulf between duck gut and human lung is so broad that an intermediate host is thought to be needed to act as a stepping stone for the virus.1530 [1788] R20;And poultry,R21; said a spokesperson for the Department of Homeland SecurityR17;s National Center for Foreign Animal and Zoonotic Disease Defense, R20;are likely to be that host.R21;1531 [1789] Bird flu viruses only R20;heat up,R21; in the words of Dutch virologist Albert Osterhaus, the virologist whose lab first identified human H5N1 infection, R20;when they pass from wild birds to poultry.R21;1532 [1790] Drs. E. Fuller Torrey, director of the Stanley Medical Research Institute, and Robert H. Yolken, a neurovirologist at Johns Hopkins University School of Medicine, concluded in their book, Beasts of the Earth: Animals, Humans, and Disease, R20;If ducks had not been domesticated, we might not even be aware of the existence of influenzaR30;.R21;1533 [1791] H5N1 discoverer Kennedy Shortridge agrees: R20;When you domesticate the duck,R21; he said, R20;you unwittingly bring the flu virus to humans.R21;1534 [1792] Although for a brief period of the year remote Canadian lakes can swarm with virus,1535 [1793] a greater danger for humans may lie in the raising of domesticated ducks year-round on southern China rice paddies, leading to what Shortridge calls a R20;virus soupR21; of stagnant water and duck feces.R21;1536 [1794] Iowa State UniversityR17;s Center for Food Security and Public Health wrote: R20;Humans have altered the natural ecosystems of birds through captivity, domestication, industrial agriculture, and nontraditional raising practices. This has created new niches for AI [avian influenza] virusesR30;.R21;1537 [1795] The combination of what may be the greatest concentration of virus in the world with densely domesticated poultry and pigs to act as stepping stones may have been what enabled influenza to take on the human species.1538 [1796] For a virus so perfectly adapted to the gut of wild waterfowl, the human lung is a long way from home. What is influenza, an intestinal waterborne duck virus, doing in a human cough? Imagine an infected duck transported to a live poultry market. The duck is crammed into a cage stacked high enough to splatter virus-laden droppings everywhere. Even if the vendor or customer were hit directly by the infected feces, humans might be too alien for the unmutated duck virus to take hold. But what if the virus reached land-based birds like quail or chickens? Terrestrial birds are not natural hosts for influenza,1539 [1797] but they are recognizable enough by the virus to infect them. The virus then faces a problem, and the solution may be hazardous to human health. All viruses must spread or perish. Like a fish out of water, when the influenza virus finds itself in the gut of a chicken, it no longer has the luxury of easy aquatic spread. It can no longer remain a strictly waterborne virus. Although the virus can still spread through feces when chickens peck at each otherR17;s droppings, in the open air, it must, for example, resist dehydration better.1540 [1798] The virus must also presumably adapt to the novel body temperature and pH of its new environment.1541 [1799] In aquatic birds, the virus is and has been in total evolutionary stasis.1542 [1800] But, when thrown into a new environment, it quickly starts accumulating mutations to try to adapt to the new host.1543 [1801] The virus must mutate or die.1544 [1802] R20;Unless it mutates,R21; said one renowned flu researcher, R20;and unless a new mutant is selected, itR17;s going to disappear.R21;1545 [1803] Thankfully for the virus, mutating is what influenza does best.1546 [1804] And, given enough time and enough hosts within which to mutate, some bird flu viruses can learn how to invade other organs in search of a new mode of travel. Sometimes, they find the lungs. In ducks, the virus keeps itself in check. The virus relies on a healthy host to fly it from lake to lake. To protect its natural host, the virus has seemed to have evolved a built-in, fail-safe mechanism that allows the virus to replicate only in the intestine, so as not to infect other tissues and potentially hurt the duck. To prevent itself from replicating outside the digestive tract, millions of years of evolution seem to have engendered an activation step. Before the virus can become infectious, its hemagglutinin spike first has to be cleaved in half to activate it. This cleavage is done by specific host enzymes found only in certain tissues, like the intestinal tract. In its natural state, the influenza virus essentially gets permission from the host before tissue infection. The limited bodily distribution of the specific cleavage enzyme restricts the virus to safe areas like the gut. It would not be able to replicate in the brain or other vital organs that lack the specific cleavage enzyme required for activation. This is a restriction the virus has seemingly imposed upon itself, evolving harmlessness to best pass on and spread its genes.1547 [1805] But once it finds itself in unfamiliar species, all bets are off. Researchers have shown that H5N1 seemed to enter chicken populations as an intestinal virus but left as more of a respiratory virus.1548 [1806] Landing in foreign territory, not only is it advantageous to find new ways to spread, but the virus also faces a hostile immune response and finds itself fighting for its life. ItR17;s either you or me, it R20;reasons,R21; so in certain cases, the virus is able to eliminate the fail-safe mechanism that restricts it to the gut. The hemagglutinin spike of H5 and H7 viruses can mutate over time to be activated by enzymes in any organ in the body, allowing the virus to go on a rampage and essentially liquefy the bird from the insideR12;the R20;flubolaR21; phenomenon of highly pathogenic avian influenza.1549 [1807] Of course, viruses donR17;t reason. This is an example of high-speed natural selection. Even in ducks, influenza viruses exist as a swarm of mutants, each subtly different from the others. Since time immemorial, though, the same perfected, harmless mutant has won out over all the others time and time again. Deadly mutants find themselves grounded by the shore in a dying bird never to propagate to other locales. Harmful viruses are dead ducks. Like other parasites, viruses tend to evolve toward a common agenda over time. Only when backed into a corner in new hostile territory might it be beneficial for the parasite to kill its host. The virus can be forced into what evolutionary biologists call an R20;acute life strategyR21; in which its only choice may be to rapidly overwhelm the host to gain a foothold.1550 [1808] Syphilis, for example, emerged more than 500 years ago as an acute, severe, debilitating disease, but has evolved into the milder, chronic form. Known in Renaissance Europe as the Great Pox, it had the ability to ulcerate faces off victims like leprosy and form great abscesses of pus. R20;Boils are exploding in groins like shells,R21; read one contemporary description, R20;and purulent jets of clap vie with the fountains in the Piazza Navona.R21;1551 [1809] For a sexually transmitted disease, however, virulence may not be conducive to transmissibility. Overt manifestationsR12;like losing oneR17;s noseR12;may tip off and turn off potential sexual partners, reducing the selective advantage of aggressive strains of the disease.1552 [1810] The best studied example of this phenomenon is the intentional introduction of the rabbitpox virus into Australia. In the 1950s, rabbits were introduced for hunting purposes, but lacking natural predators, they rapidly populated the continent.1553 [1811] To kill off the rabbits, scientists introduced a rabbitpox virus isolated from a Brazilian rabbit species to which the virus had co-evolved an aggressive symbiosis.1554 [1812] Within a year, the virus had spread a thousand miles in each direction, killing millions of rabbits with a 99.8% mortality rate.1555 [1813] To the bane of the farmers (but the benefit of the bunnies), by the second year, the mortality rate was down to 90% and eventually dropped to only 25%, frustrating attempts to eradicate the cotton-tailed menace.1556 [1814] The rabbitpox virus was faced with a trade-off. On the level of a single, individual host, it was presumably in the virusR17;s best interest to attain maximal virulence, replicating and destroying at full bore to overwhelm the rabbitR17;s immune defenses in hopes of spreading outward to other rabbits. If the immune system got the upper hand first, there was little chance the virus could pass on its genes. This tendency towards maximum virulence, though, was counterbalanced by the need for effective transmission on a population level. By rapidly overcoming the host, the virus may have won the battle but lost the war.1557 [1815] If a virus kills the host too quickly, there is less opportunity to spread in both time and space. Just as dead ducks donR17;t fly, dead rabbits donR17;t hop. Unless farmers could cram rabbits by the thousands into some kind of bunny barn, viral mutants with diminished lethality may have an overall advantage since the host may stay alive longer and have more occasion to pass on the virus. This is a risky strategy for the virusR12;if it becomes too weak, the hostsR17; defenses may quash it completely. Natural selection mediates this evolutionary process, choosing over time the virus with the perfect balance of lethality and contagion.1558 [1816] This doesnR17;t always mean a transition toward lesser virulence. R20;If predator-like variants of a pathogen population out-produce and out-transmit benign pathogens,R21; wrote one evolutionary medicine pioneer, R20;then peaceful coexistence and long-term stability may be precluded much as it is often precluded in predator-prey systems.R21;1559 [1817] H5N1, in this case, seems the model predator. The tendency of the influenza virus, finding itself locked in a host as unfamiliar as a chicken, may be to become as virulent as possible to overpower the birdR17;s defenses.1560 [1818] The deadlier the better, perhaps. DonR17;t the same constraints apply though? If the virus kills the chicken too quickly, how can it then infect others? Enter intensive poultry production. When the next beak is inches away, there may be fewer limits to how nasty influenza can get. (c) BirdFluBook.com | Home [1819] | Website by Lantern Media [1820] Bird Flu - R20;In our efforts to streamline farming practices to produce more meat for more people, we have inadvertently created conditions by which a harmless parasite of wild ducks can be converted into a lethal killer of humans.R21; BirdFluBook.com [1821] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1822] R20;In our efforts to streamline farming practices to produce more meat for more people, we have inadvertently created conditions by which a harmless parasite of wild ducks can be converted into a lethal killer of humans.R21; R12;Johns Hopkins neurovirologist R.H. Yolken and Stanley Medical Research Institute director E.F. Torrey1561 [1823] Earl Brown, PhD., Professor, Biochemistry, Microbiology and Immunology, University of Ottawa All bird flu viruses seem to start out harmless, arising out of the perpetual, benign, stable reservoir of innocuous waterfowl influenza. They start out as mild, low-grade, so-called LPAI viruses, low-pathogenicity avian influenza. H5 and H7 viruses, however, have the potential to mutate into virulent, high-grade, R20;fowl plagueR21; viruses, now known as HPAIR12;highly pathogenic avian influenza. HPAI viruses arenR17;t born; theyR17;re made. The World Health Organization explains in its 2005 assessment of the pandemic threat: Highly pathogenic viruses have no natural reservoir. Instead, they emerge by mutation when a virus, carried in its mild form by a wild bird, is introduced to poultry. Once in poultry, the previously stable virus begins to evolve rapidly, and can mutate, over an unpredictable period of time, into a highly lethal version of the same initially mild strain.1562 [1824] Scientists have demonstrated this transformation in a laboratory setting. A collaboration of U.S. and Japanese researchers started with a harmless virus isolated from waterfowl, H5N3 from a whistling swan in this case, and proceeded to do serial passages through baby chickens. First, the researchers took day-old baby chicks and squirted a million infectious doses into their lungs. Over the next few days, the virus would presumably start to adapt to the chicksR17; respiratory tracts, with the viral mutant that learned best, through trial and error, to undermine the hatchlingsR17; defenses selected to predominate. After three days they killed the chicks, ground up their lungs, and squirted the viral lung slurry down the throats of other chicks. They again allowed a few days for the virus to adapt further before repeating the cycle two dozen times. When they killed the last set of chicks, the researchers ground up their brains instead of their lungs and infected five additional rounds of healthy chicks with the brain pulp. With every passage, the virus grew more adept at overwhelming and outwitting the fledging birdsR17; immune systems to best survive and thrive in its new environment. The final infected brain sample, after two dozen cycles though lungs and five cycles through brain, was squirted into the nostrils of healthy adult chickens. If you do this with the original swan virus nothing happens, but influenza is a fast learner. By the 18th lung passage, the virus was able to kill half of the chickens exposed. After the final five brain passages, the virus was capable of rapidly killing every single one. The researchers concluded: R20;These findings demonstrate that the avirulent [harmless] avian influenza viruses can become pathogenic during repeated passaging in chickens.R21;1563 [1825] If mad scientists wanted to create a bird flu virus of unprecedented ferocity, they could try to continually keep cycling the virus through chickens. Imagine if the serial passaging was done not two dozen times, but 20,000 times. What kind of virus would come out the other end? The World Organization for Animal Health and the Food and Agriculture Organization of the United Nations agree that it has been R20;prove[n]R21;1564 [1826] that once LPAI viruses gain access to poultry facilities, they can R20;progressively gain pathogenicity in domestic birds through a series of infection cycles until they become HPAI.R21;1565 [1827] However, deadly bird flu viruses donR17;t tend to arise in just any poultry operation. According to USDA researchers, itR17;s the R20;high density confinement rearing methodsR21; that give bird flu R20;a unique chance to adapt to the new species.R21;1566 [1828] That is, todayR17;s intensive farming practices may remove the natural obstacles to transmission that prevent the virus from becoming too dangerous. David Swayne is the USDAR17;s leading bird flu researcher. Director of the USDAR17;s chief poultry research laboratory, Swayne has authored more than 100 scientific publications on avian influenza.1567 [1829] According to Swayne, there has never been a recorded emergence of an HPAI virus in any backyard flock or free-range poultry operation. This is not surprising. Imagine an outdoor setting. A duck flying overhead drops a dropping laden with relatively innocuous virus into a grassy field through which a flock of hens is pecking. The hens may be exposed to the virus, but coming straight from waterfowl, the virus is so finely tuned to duck physiology that it may not gain a foothold before being wiped out by a healthy chickenR17;s immune system. ThatR17;s why in the lab, researchers injected infected lung tissue from one bird to another to facilitate transmission. R20;The conditions under which we generated highly virulent viruses from an avirulent strain are generally not duplicated in nature,R21; the research team admitted. R20;However, viruses with low pathogenicity can cause viremia in physically compromised chickens.R21;1568 [1830] Viremia means successful invasion of the bloodstream by the virus, an incursion they deem more likely to occur in compromised hosts. If an outdoor flock does manage to get infected, the virus still has to keep spreading to remain in existence. Influenza virus is rapidly killed by sunlight and tends to be dehydrated to death in the breeze. Its ability to spread efficiently from one chicken to the next outside in the open air is relatively limited. In a sparsely populated outdoor setting, there may simply be too few susceptible hosts nearby to passage between in order to build up enough adaptive mutations to do more than ruffle a few feathers. There was a deadly outbreak among wild sea-birds in South Africa in 19611569 [1831] and a 2004 outbreak on two ostrich feedlots,1570 [1832] and rare sporadic outbreaks of highly pathogenic bird flu viruses date back more than a century,1571 [1833] but these seem to be exceptions to the rule. According to bird flu expert Dennis Alexander of the U.K.R17;s Central Veterinary Laboratory, with the possible exception of the ostriches (which were kept at unnaturally high stocking densities in reportedly stressful unhygienic conditions),3172 [1834] highly pathogenic influenza viruses have R20;never known to arise in an outdoor flock.R21;1572 [1835] Now imagine the mad scientist scenario. Tens of thousands of chickens crammed into a filthy, football field-sized broiler shed, left to lie beak-to-beak in their own waste. The air is choked with moist fecal dust and ammonia, which irritates the birdsR17; respiratory passages, further increasing susceptibility in chickens already compromised by the stress of confinement. Since the birds are standing in their own excrement, the virus need not even develop true airborne transmission via nasal or respiratory secretions. Rather, the virus has an opportunity to be excreted in the feces and then inhaled or swallowed by the thousands of other birds confined in the shed, allowing the virus to rapidly and repeatedly circulate. With so many birds in which to readily mutate, low-virulence strains can sometimes turn into deadly ones. The dose of virus transmitted from one bird to another might also play a crucial role. Earl Brown specializes in influenza evolution. He studies how the virus acquires virulence and adapts to new species. In a landmark study published in the Proceedings of the National Academy of Sciences of the United States of America, he showed R20;that a group of 11 mutations can convert an avirulent virus to a virulent variant that can kill at a minimal dose.R21; Instead of studying waterfowl viruses in chickens, he studied human viruses in a similarly unnatural hostR12;mice. Mice can be experimentally infected with human flu strains, but they donR17;t get sick. The virus is adapted to taking over and killing human cells, not mouse cells. Human viruses tend to replicate so poorly within a mouse that the mouseR17;s immune system wipes it out before the virus can cause so much as the sniffles. If the human virus is dripped directly into a mouseR17;s nostrils, though, and then you grind up the mouseR17;s lungs and drip the viral-infected lung tissue into another mouseR17;s nose and the cycle is repeated, in as few as a dozen cycles, the virus, which started out totally harmless, comes out the other end causing fatal pneumonia in the mice.1573 [1836] Investigators have found that the key to this ramping up of virulence may be the size of the infectious dose that gets transferred from one animal to another. In the swarm of viral mutants in every infected mouseR17;s lungs, odds are that there are few capable of R20;heightened exploitation of the host.R21;1574 [1837] But, if these mutants never find their way into another mouse, they will be wiped out along with the others. So even if an infected mouse were to rub noses with another mouse and transfer some small level of infection, chances are slim that the rare virulent mutants would happen to find their way into the next mouse. In fact, since influenza is so sloppy at replicating, the majority of mutants may be relatively dysfunctional, so a small transferred dose may actually cause the virus to lose potency.1575 [1838] So itR17;s not just the number of animals that doses of virus get transferred betweenR12;size really does matter. The greater the number of viruses transferred or R20;passagedR21; from one animal to the other, the greater the pool natural selection has to select from. Professor Brown described it to me like trying to win the lottery. If you only buy a few tickets at a time, the chance of winning the jackpot is slim. But what if you bought all the tickets? The evolution of hypervirulence, as seen in viruses like H5N1, may require an enormous viral load seen only in rather unique circumstancesR12;artificial inoculation in a laboratory or animals intensively confined in their own waste. Inside an industrial broiler shed there can be high dose transmission through thousands of hostsR12;what Brown calls the R20;nub and the cruxR21; of the development of extreme viral virulence.1576 [1839] Highly pathogenic bird flu viruses are primarily the products of factory farming.1577 [1840] (c) BirdFluBook.com | Home [1841] | Website by Lantern Media [1842] Bird Flu - Chicken Surprise BirdFluBook.com [1843] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1844] Chicken Surprise Chickens may be duck to human stepping stones3043 [1845] The mad scientist scenario of intensive poultry production has been replicated around the globe. Viral transformations from harmless to deadly have been documented in the outbreaks in Pennsylvania in the 1980s, Mexico,1578 [1846] Australia, Pakistan,1579 [1847] and Italy in the 1990s, and in Chile, the Netherlands, and Canada since 2002.1580 [1848] These outbreaks have collectively led to the deaths of millions upon millions of chickens, but does this mean highly pathogenic bird flu viruses are more dangerous to humans? The CDC thinks this is likely the case.1581 [1849] Adaptation to land-based birds involves alterations of the virus in ways that may present increased human risk.1582 [1850] Any modification that enhances airborne transmission, for example, such as improved resistance to desiccation, could amplify risk to people. Certainly the mutation that allows the virus to rage throughout all organ systems may contribute to the ability of viruses like H5N1 to cross the species barrier into humans1583 [1851] and present a greater threat.1584 [1852] In order to create a human pandemic, though, the virus has to be able to bind effectively to human receptors.1585 [1853] ThatR17;s why weR17;ve been so concerned about pigs. Ducks have the 2,3 linkages, humans have the 2,6 linkages, and pigs have both. So, in a pig, the duck virus could theoretically accustom itself to our receptors and burst throughout the human population.1586 [1854] Unfortunately for the human race, researchers recently discovered that chickens have human 2,6 receptors in their lungs as well.1587 [1855] A pandemic virus faces a paradoxical twin challenge: It must be new to the human immune system, so thereR17;s no pre-existing immunity, while at the same time being supremely well adapted to infect us.1588 [1856] Mikhail N. Matrosovich at the Russian Academy of Sciences in Moscow discovered what may be a critical piece of the pandemic puzzle by demonstrating that, unlike ducks, chickens can tightly bind human influenza viruses and vice versa. This, Matrosovich wrote, could lead to the emergence of bird flu viruses with R20;enhanced propensity for transmission to humans.R21;1589 [1857] In addition to the presence of human-like 2,6 linkages in the respiratory tracts of chickens, thereR17;s evidence of a second sialic acid binding site on the virus, the significance of which is unknown. This second binding site is highly conserved in the aquatic bird reservoir, but lost in both chickens and humansR12;another similarity on a molecular level between the lungs of chickens and humans that may make viral adaptations to one applicable to the other.1590 [1858] A third line of molecular evidence that implicates chickens as the pale Trojan horse of the apocalypse has to do with the length of ganglioside sugar chains. Gangliosides are complex fatty molecules jutting out of our cell membranes that display chains of sugars. It is not enough for the influenza virus to hook onto the sialic acid receptors on one of our cells; the virus must then fuse with the cell and spill its nefarious contents inside to take over. The virus must not only dock, but pry open the bay doors. This may be where these ganglioside sugar chains come into play, facilitating the virusR17;s fusion and entry process.1591 [1859] The exact role gangliosides play remains speculative, but we do know that influenza viruses from different species have distinct binding preferences as to the length of these sugary chains. Duck viruses have an affinity for the short chains that are abundant in duck intestines, whereas human viruses have an affinity for the longer chains found in primate lung tissue. Part of the duck-human species barrier, then, may be that duck viruses prefer short chains, yet human cells exhibit more long chains. Chickens are in the middle. As a duck virus circulates among chickens, there may be a selection pressure on the virus to attach to longerR12;and therefore more human-likeR12;chains to better adapt and spread within and between chickens. H5N1, for example, which as a waterfowl virus presumably preferred short chains, has mutated in favor of an affinity for longer chicken chains, on a potential trajectory toward more efficient human infection. In fact, chicken flu viruses bind tighter to human cells than they do to duck cells. As a result of some strange twist of evolutionary fate, from the standpoint of the influenza virus, chickens may look more like people than they do like ducks. When waterfowl viruses that are essentially harmless infect chickens, they may start accumulating mutations that make them more dangerous to chickens and humans alike.1592 [1860] Evidence continues to build to support this hypothesis.1593 [1861] In developing a taste for chicken, these viruses may acquire a taste for us. Analysis of the 1918 virus protein sequences suggests that the transformation into a pandemic virus may be easier than previously thought. Just a single point mutation may change a virus that binds duck 2,3 receptors to a virus that binds human 2,6 receptors.1594 [1862] The researchers who resurrected the 1918 virus found that the receptor binding site on the virus differed from the binding site of its presumed avian precursor by just one or two tiny amino acid substitutions, presumably all it needed to go human. Many experts expect H5N1 to similarly strike gold, line up the cherries, and cash in at our expense. Adaptation to a human host requires more than just viral access into human cells. The internal viral machinery still has to evolve to best take over our cells, but viral entry is the first step. This surreptitious similarity between chicken and human receptors may better enable bird flu viruses like H5N1 to transition from infecting billions of chickens to infecting billions of humans. This may be thought of as an example of exaptation, a concept in evolutionary biology by which an adaptation in one context coincidentally predisposes success in an unrelated context. LegionnaireR17;s disease is the classic example.1595 [1863] LegionnaireR17;s is caused by bacteria whose primary evolutionary niche is the scum lining the rocks of natural hot springs. As it evolved to thrive within this warm, moist environment, it happened to be evolving to thrive within the warm, moist environment of the human lung as well. Of course, the bacteria had little occasion to find itself within our lungs, since weR17;re good about keeping water out of our windpipes (lest we drown). But then machines were invented, like air conditioners, which have the capacity to mist water into the air, as evidenced by the famous Philadelphia outbreak in 1976 at an American Legion convention in which the hotel ventilation system conditioned the air with bacteria now known as Legionella.1596 [1864] In the environment of the human respiratory tract, LegionellaR17;s prior adaptations proved lethal. In the case of influenza viruses that may have pandemic potential like H5N1, chickens may be thought of as acting as both hot springs and air conditioner, providing the media by which the virus can adapt and propagate to the populace. The evolutionary distance from duck to human seems too far for a direct jump by influenza, but with chickens sharing binding characteristics of each, they may act as stepping stones to bridge the huge species gap.1597 [1865] There is evidence that other land-based domesticated fowl, such as quail and pheasant, can also act as intermediaries and may play a minor role,1598 [1866] but we donR17;t tend to raise them like we do chickens. Although there was an outbreak of H5N2 on a farm raising more than 100,000 quail in Oregon in the 1980s, operations that size for birds other than chickens are the exception.1599 [1867] Indeed, chickens would seem the most threatening possible species to be exhibiting human virus binding attributes, as they are the one animal in the world we raise by the tens of billions every year. In nature, as a waterborne virus, influenza has been known to infect aquatic mammals like whales and seals,1600 [1868] but how many whales can you fit in a broiler shed or battery cage? (c) BirdFluBook.com | Home [1869] | Website by Lantern Media [1870] Bird Flu - Out of the Trenches BirdFluBook.com [1871] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1872] Out of the Trenches Boxcars were labeled "8 horses or 40 men." In 1918, chickens were still pecking around the barnyard. Industrial chicken factories didnR17;t take off until after the second World War. How then could a pandemic virus of such ferocity have arisen? Nobody knows for certain, but evolutionary theory allows us to speculate. The development of extreme virulence is thought to require an overcrowding of susceptible hosts who cannot escape from one another. Otherwise, the virus needs to restrain itself. If a bird flu virus gets too vicious, if the bird gets too ill too fast, the virus is less likely to infect othersR30;unless the next beak is just inches away. That wasnR17;t the case in 1918. There were no reports of mass bird die-offs, nor would one expect any since the 1918 virus was H1, and only H5 and H7 viruses are thought capable of mutating into highly pathogenic forms in chickens. In 1918, there were no stress-compromised chickens teeming with virus crammed into enclosed spaces en masse. In 1918, the virus didnR17;t learn how to kill humans crowded in filthy chicken sheds. Instead, it may have gotten that education in the trenches of World War I. In 1918, the soldiers may have been the chickens. Military medical historian Carol Byerly argues in her 2005 book Fever of War: The Influenza Epidemic in the U.S. Army During World War I that the 1918 virus built up its virulence in the transport ships, trains, and trenches of the Great War.1601 [1873] Millions of young men were forced together in close quarters where there was no escaping a sick comrade. Instead of battery cages of egg-laying chickens, battery units of infantry dug themselves into festering trenches. Instead of ammonia to irritate the respiratory tracts of chickens and predispose them to infection, residues of poison gases like chlorine saturated the Western Front.1602 [1874] The unspeakable conditions, the theory goes, led to the perfect breeding ground for influenza superstrains: a population of R20;physically compromisedR21; individuals under intense confinement undergoing mass troop movements, not unlike live animal transports. In both cases, fodder for slaughter.1603 [1875] Boxcars were labeled R20;8 horses or 40 men.R21;1604 [1876] Evolutionary biologist Paul Ewald agrees that the crowded, stressful, unhygienic WWI conditions could have favored the evolution of a R20;predator-like virusR21; that otherwise may have killed too quickly to spread with peak efficiency under normal conditions.1605 [1877] If this controversial theory is correct, how might the virus have gotten into the trenches in the first place? There are a number of competing theories as to the true origin of the virus, all of them contentious.1606 [1878] University of Hong KongR17;s Shortridge thinks it may have originated in Asia, conveyed to the front by Chinese laborers brought in to dig trenches for the Allies.1607 [1879] Contemporary accounts have the workers speaking the Cantonese dialect of Guangdong Province (then Canton), the region harboring domesticated ducks for centuries alongside the highest concentration of people, pigs, and poultry in the world.1608 [1880] The 1918 U.S. Surgeon GeneralR17;s report on the Spanish flu indeed alluded to an Asian origin.1609 [1881] An avian virus may have smoldered in the Chinese population before serendipitously finding itself in the trenches, like a duck virus in a broiler chicken shed.1610 [1882] Royal London HospitalR17;s John Oxford, on the other hand, points to declassified military medical records showing excessive numbers of deaths from respiratory infection in French military camps before the Chinese laborers arrived.1611 [1883] The R20;heliotrope cyanosisR21; (bluish-purple skin discoloration) described in these reports does share a resemblance to the millions of cases that were soon to come.1612 [1884] He suggests that the virus arose in the battlefield. R20;Wounded survivors of gas contaminated battlefields gather in the Great City British Army Camp of Etaples in northern France,R21; Oxford explains, R20;in close proximity with each other, with geese and poultry markets of the area and even pig farms installed right into the army camp itself.R21;1613 [1885] On any one day, the army base crowded 100,000 soldiers into tents and temporary barracks, a ripe setting for a respiratory virus. Survivors from the trenches crossed paths with more than a million men from England on their way to the Western Front in the Etaples camp alone. Combine the population density with the geese, chickens, and pigs raised for slaughter in the camps, Oxford notes, and R20;[t]hose conditions mimic what naturally occurs in Asia.R21;1614 [1886] In the absence of air travel, the virus may have simmered for months or years in such a camp, relying on the demobilization in the fall of 1918 for rapid global dispersal.1615 [1887] Others think the pandemic 1918 virus was made in the USA. The American Medical Association sponsored what many consider to be the most comprehensive of several international investigations into the pandemic. Written by the editor of the Journal of Infectious Disease, the AMA report was published in 1927. The intervening years were spent reviewing evidence from around the world. The AMA concluded that the most likely site of origin of the 1918 virus was Haskell County, Kansas.1616 [1888] The first wave of the pandemic in the spring of 1918 was so mild that it did not merit special mention in the medical journals of the time.1617 [1889] The virus still had a lot to learn. The AMA was able to track the spread of this mild spring wave from the first recorded case on March 4, 1918,1618 [1890] at Camp Funston (now Fort Riley) in Kansas. Patient zero was a soldier recorded cleaning pig pens prior to his infection.1619 [1891] Maybe a Canadian goose flew the virus to Kansas, infecting a pig, who infected a man. We will probably never know. From the Midwest, the flu virus spread along the rail lines from Army camp to Army camp,1620 [1892] then into the cities, and finally traveled with the troops to Europe.1621 [1893] The virus found itself not in Kansas anymore. An equally authoritative multivolume British analysis of the pandemic agreed with the AMA: R20;The disease was probably carried from the United States to Europe.R21;1622 [1894] A Nobel Laureate who spent most of his research career studying influenza also concluded that the available evidence was R20;strongly suggestiveR21; that the virus started in the United States and spread with R20;the arrival of American troops in France.R21;1623 [1895] Over the summer of 1918, the virus mutated into a killer.1624 [1896] Just as low-grade influenza viruses may infect free-range fowl, so too may they infect free-range Frenchmen. The highly unnatural wartime conditions may have allowed the virus to achieve its full lethal potential. The critical component, Ewald argues, R20;is something that chicken farms have in common with the Western Front: large numbers of hosts packed so closely that even immobilized hosts can transmit the virus to susceptibles.R21;1625 [1897] Once the ability of the virus to spread no longer depends on the host feeling well enough to move around in order to infect others, there may be little Darwinian limit to how fierce the virus can get.1626 [1898] In the wild, if a bird gets too sick, too fast, the virus isnR17;t going anywhere. Stick a sick chicken in a broiler shed, though, or a sick soldier in a troop transport, and the uninfected can no longer escape their sick companion. The key to the evolution of virulence may be the packing together of the infected with the uninfected, beak-to-beak or shoulder-to-shoulder.1627 [1899] Ewald is uncompromising on this point: [W]e will continue to get severe influenza epidemics in chicken farms so long as the conditions in chicken farms, like the conditions at the Western Front, allow transmission from immobile chickens. This prediction has been confirmed by the lethal outbreaks of H5N1 in Asia and H5N2 in Mexico. Anyone who dismisses this analysis as speculation does not understand how the scientific process works or what scientific theory actually is, at least with regard to evolutionary biology.1628 [1900] The author of Fever of War emphasizes the uniqueness of the conditions that led to the pandemic. R20;The 1918 flu epidemic most likely will not happen again,R21; she said, R20;because we wonR17;t construct the Western Front again.R21;1629 [1901] She fails to take into account that the same stress, filth, and crowding of trench warfare exists in nearly every industrial egg farm and chicken facility the world over. Even Ewald, though convinced that the overcrowding of intensive poultry production made H5N1 into the killer it is today,1630 [1902] seemingly fails to recognize the newfound genetic similarities between chickens and humans that make viral evolution in the egg farm and the broiler house a sobering concern for us all.1631 [1903] The idiosyncratic likeness between the viral binding capacity to both chicken and human respiratory linings may allow chickens to stand in as our surrogates for the evolution of human transmissibility. Though millions fought along the Western Front, we keep birds in the trenches by the billions. (c) BirdFluBook.com | Home [1904] | Website by Lantern Media [1905] Bird Flu - A Chicken in Every Pot BirdFluBook.com [1906] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1907] A Chicken in Every Pot Chickens now and then America invented industrial poultry production, yet a century ago in the United States, chickens were more prized as showpieces than dinner table centerpieces. Chickens, like many fancy pigeon breeds of today, were bred more for exhibition than consumption. Only around 1910 did raising these birds for eggs supersede raising them for show.1632 [1908] When Herbert Hoover promised R20;a chicken in every potR21; in 1928, AmericaR17;s entire annual per-capita consumption could fit in a potR12;Americans were eating an average of only a half-pound of chicken a year.1633 [1909] By 1945, the figure stood at five pounds per year. The sea change happened after World War II.1634 [1910] Current chicken consumption is around 90 pounds a year,1635 [1911] over half a bird a week.1636 [1912] Chicken used to be more expensive than steak or lobster in the United States; poultry may now be cheaper than the potatoes with which itR17;s served.1637 [1913] In past-CEO Don TysonR17;s words, corporations R20;control the center of the plate for the American peopleR21;1638 [1914] by turning a holiday or Sunday dinner into everyday fare through R20;least cost production,R21;1639 [1915] an intense pressure to keep live production costs as low as possible.1640 [1916] The first hurdle was to keep birds captive indoors in order to produce year-round.1641 [1917] Without enough exercise and natural sunlight exposure, though, flocks raised in warehouses suffered from rickets and other developmental disorders. The discovery of the R20;sunshineR21; vitamin D in 19221642 [1918] finally allowed for total confinement,1643 [1919] enabling producers to use near-continuous artificial light to increase feed-to-flesh conversion.1644 [1920] As in the case of antibiotic growth promotants, such technological fixes have allowed the poultry industry to profit in the short term by undermining natural safeguards, but at what long-term cost? Intensive confinement, while R20;more economical,R21; according to USDA researchers, has the R20;unfortunate consequence that disease outbreaks occur more frequently and with greater severity.R21;1645 [1921] Many of the early indoor broiler operations of the 1920s and R17;30s were wiped out by contagious disease fostered by the crowded conditions,1646 [1922] making it impossible to maintain large flocks economically.1647 [1923] Overcrowding took over the egg industry, too. In 1945, the typical henhouse held 500 egg-laying birds; today there are avian megalopolises, caging 100,000 or more hens in a single shed on a single egg farm.1648 [1924] This was made possible in part by the antibiotic revolution. As one farmer admitted, R20;The more intensive farming gets, the more props you need. You crowd the animals to save every cent you can on space; then you have to give them more antibiotics to keep R17;em healthy.R21;1649 [1925] The history of the poultry industry is a history of disease. As soon as one epidemic was subdued, another soon seemed to emerge.1650 [1926] Bacterial diseases like fowl typhoid and tuberculosis gradually gave way over the century to viral scourges.1651 [1927] In the 1960s, a hypervirulent form of MarekR17;s disease was discovered, a destructive cancer virus that led to the condemnation of as many as one-fifth of U.S. broiler chicken flocks.1652 [1928] In the 1970s, exotic Newcastle disease, a viral invasion of the nervous system, caused the deaths of 12 million chickens.1653 [1929] In the 1980s, H5N2 struck Pennsylvania and destroyed 17 million, our worst bird flu outbreak in the United States to date.1654 [1930] In the 1990s, parasitic diseases like blackhead diseaseR12;once considered under controlR12;re-emerged,1655 [1931] and some bacteria reincarnated as antibiotic-resistant superbugs.1656 [1932] In a review of the unrelenting global outbreaks of epidemic disease, a North Carolina veterinary poultry specialist wrote in World Poultry, R20;The intensification of the poultry industry seems to be paying its toll.R21;1657 [1933] GRAIN, a respected agricultural research organization, points out a parallel between Newcastle disease and avian influenza in its briefing Fowl Play: The Poultry IndustryR17;s Central Role in the Bird Flu Crisis.1658 [1934] Newcastle is another avian virus that may mutate into a highly pathogenic form if it finds its way into an intensive confinement environment. The GRAIN report points to the example of a sudden Australian outbreak of Newcastle in 1998 that led to the destruction of 100,000 chickens. Though the virus was originally assumed to have been brought into the country from overseas, virologists at the Australian Animal Health Laboratory concluded that a benign local strain had mutated into a highly virulent form.1659 [1935] Vaccinations were mandated for all chickens on any farm with more than 1,000 birds. The government explained why small farms and backyard flocks were exempt: R20;All the available evidence indicates that, for such a mutation to occur, it needs a large number of birds in a small area to R16;generateR17; the virus mutation process. In simple terms, a small number of birds cannot generate enough virus for the mutation process to occur.R21;1660 [1936] Even with total control over the animalsR17; lives and movements, and an arsenal of vaccines, antimicrobials, and deworming agents, intensive food animal industries remain plagued with disease epidemics.1661 [1937] In intensive pig production, certain internal parasites have been eliminated, but respiratory diseases like influenza have intensified.1662 [1938] In the poultry industry, according to an avian virology textbook, R20;confined, indoor, high-densityR21; facilities R20;create an ideal environment for the transmission of viruses, particularly those that are shed from the respiratory or gastrointestinal tract.R21;1663 [1939] The flu virus can be shed from both. (c) BirdFluBook.com | Home [1940] | Website by Lantern Media [1941] Bird Flu - R20;You have to say that high intensity chicken rearing is a perfect environment for generating virulent avian flu virus.R21; BirdFluBook.com [1942] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1943] R20;You have to say that high intensity chicken rearing is a perfect environment for generating virulent avian flu virus.R21; R12;University of Ottawa virologist Earl Brown1664 [1944] Intensive confinement of chickens Given the existence of diseases like bird flu with potentially disastrous human health consequences, the propensity of large-scale poultry production to generate diseaseR12;the so-called R20;industrial ecology created by intensive confinementR21;R12;has, as an academic technology journal describes, R20;ramifications far beyond the chicken house.R21;1665 [1945] In the end, chickens may not be the only ones to fall sick. Modern corporate chicken sheds cluster tens or hundreds of thousands of chickens into what are essentially giant slums.1666 [1946] These animals spend their entire short lives eating, sleeping, and defecating in the same cramped quarters, breathing in particles of their neighborsR17; waste and the stinging ammonia of decomposing feces. Their first breath of fresh air is on the truck to the slaughter plant. In this kind of environment, mass disease outbreaks may be inevitable.1667 [1947] R20;The primary driver has been economicsR12;short-term gain,R21; says the director of the Toronto General HospitalR17;s Centre for Travel and Tropical Medicine. R20;We bring tens of thousands of animals together, crush them into these abnormal environments, poke them full of whatever and make them fatter for sale. Any microbe that enters that population is going to be disseminated to thousands of animalsR30;.R21;1668 [1948] Intensive poultry production diminishes the cost to the individual consumer, but may present an intolerable cost to humanity at large. A number of prominent journalists worldwide have arrived at this idea of factory farms as potential pandemic hatcheries. Theresa Manavalan, a leading Malaysian journalist, asks us to R20;make no mistake, the pig is not the villain, neither is the chicken. ItR17;s actually us. And our horrible farm practicesR30;. What we may have done,R21; she warns, R20;is unwittingly create the perfect launch pad for an influenza pandemic that will likely kill large numbers of people across the globe.R21;1669 [1949] Deborah Mackenzie, from the New Scientist Brussels office, writes, R20;For years we have forced countless chickens to live short, miserable lives in huge, crammed hen houses in the name of intensive agriculture. In 2004, they started to wreak their revenge.R21;1670 [1950] The WHO, OIE, and FAO, respectively the worldR17;s leading medical, veterinary, and agricultural authorities, all implicate industrial poultry production as playing a role in the current crisis. The World Health Organization blames the increasing trend of emerging infectious diseases in part on the R20;industrialization of the animal production sectorR21;1771 [1951] in general, and the emergence of H5N1 on R20;intensive poultry productionR21; in particular.1772 [1952] The OIE, the World Organization for Animal Health, blames in part the shorter production cycles and greater animal densities of modern poultry production, which result in a R20;greater number of susceptible animals reared per given unit of time.R21;1773 [1953] Said one senior Food and Agriculture Organization official, R20;[I]ntensive industrial farming of livestock is now an opportunity for emerging diseases.R21;1774 [1954] Other experts around the world similarly lay blame at least in part on R20;so-called factory farming,R21;1675 [1955] R20;intensive poultry production,R21;1676 [1956] R20;large industry poultry flocks,R21;1677 [1957] R20;intensive agricultural production systems,R21;1678 [1958] or R20;intensive confinement.R21;1679 [1959] R20;We are wasting valuable time pointing fingers at wild birds,R21; the FAO has stated, R20;when we should be focusing on dealing with the root causes of this epidemic spread whichR30;[include] farming methods which crowd huge numbers of animals into small spaces.R21;1680 [1960] In October 2005, the United Nations issued a press release on bird flu specifically calling on governments to fight what they call R20;factory farmingR21;: R20;Governments, local authorities and international agencies need to take a greatly increased role in combating the role of factory-farming, commerce in live poultry, and wildlife markets which provide ideal conditions for the virus to spread and mutate into a more dangerous formR30;.R21;1681 [1961] Emeritus professor Kennedy Shortridge was awarded the highly prestigious Prince Mahidol Award in Public Health, considered the R20;Nobel Prize of Asia,R21;1682 [1962] for his pioneering work on H5N1.1683 [1963] From 1977 to 2002, he advised the World Health Organization on the ecology of influenza viruses.1684 [1964] Shortridge describes how modern poultry operations have created the greatest risk scenario in history. R20;The industrialization is the nub of the problem,R21; he said. R20;We have unnaturally brought to our doorstep pandemic-capable viruses. We have given them the opportunity to infect and destroy huge numbers of birds andR30;jump into the human race.R21;1685 [1965] The director of the Consortium for Conservation Medicine agrees. R20;The global poultry industry is clearly linked to avian influenza [H5N1],R21; he said. R20;It would not have happened without it.R21;1686 [1966] (c) BirdFluBook.com | Home [1967] | Website by Lantern Media [1968] Bird Flu - Overcrowded BirdFluBook.com [1969] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [1970] Overcrowded Egg-laying hens in battery cages What specifically about intensive production has the worldR17;s leading public and animal health authorities up in arms? An industry trade journal listed some factors that make intensive poultry facilities such R20;idealR21;1687 [1971] R20;breeding grounds for diseaseR21;1688 [1972] : R20;poor ventilation, high stocking density, poor litter conditions, poor hygiene, high ammonia level, concurrent diseases and secondary infections.R21;1689 [1973] The first ingredient in the recipe to potentially increase the virulence of bird flu is overcrowding. In modern broiler production, 20,000 to 30,000 day-old chicks are placed on the floor atop coarse wood shavings or other litter material in an otherwise barren shed.1690 [1974] As they grow bigger, rapidly reaching slaughter-weight, the crowding grows more and more intense. According to the standard reference manual for commercial chicken production, R20;Under standard commercial conditions chickens weighing 4.5 to 6 lbs have little more than a half a square foot of living space per bird in the last two weeks of their 42R11;47 days of life.R21;1691 [1975] As one researcher reported, R20;[I]t looks as though there is white carpet in the shedsR12;when the birds are fully grown you couldnR17;t put your hand between the birds, if a bird fell down it would be lucky to stand up again because of the crush of the others.R21;1692 [1976] R20;Obviously,R21; Louisiana State University veterinary scientists write, under these conditions, R20;the potential for a disastrous epidemic is very high.R21;1693 [1977] The majority of egg-laying hens in the world are confined in battery cages1695 [1978] R12;barren wire enclosures so small that each hen is allotted less space than a standard letter-sized piece of paper.1696 [1979] A hen needs 291 square inches of space to flap her wings, 197 square inches to turn around, and 72 square inches just to stand freely.1697 [1980] Currently, U.S. commercial battery facilities allow each bird an average of 64 square inches.1698 [1981] With up to ten birds per cage and thousands of cages stacked vertically in multiple tiers, layer warehouses can average more than 100,000 chickens per shed.1699 [1982] The Royal Geographical Society notes, R20;Massive demand for chicken has led to factory (battery) farming which provides ideal conditions for viruses to spread orally and via excreta which inevitably contaminates food in the cramped conditions that most birds are kept in.R21;1700 [1983] Europe is moving away from this level of intensification, for both egg-laying chickens and chickens raised for meat. In 2005, the European Commission proposed legislation to impose a maximum stocking density for broiler chickens throughout Europe.1701 [1984] In sharp contrast to the U.S. R20;standard commercialR30;half a square foot of living space per bird,R21; certain organic standards in Britain already require more than 150 square feet per bird.1702 [1985] For the health and welfare of egg-laying hens, the European Parliament voted to ban conventional battery-cage systems entirely by 2012.1703 [1986] In a joint consultation, the WHO, FAO, and OIE noted that the sheer number of intense contacts between birds with increasing flock density serves to spread and amplify disease agents like bird flu.1704 [1987] This is supported by research showing that, not surprisingly, increasing chicken stocking densities result in an increased burden of infectious disease agents.1705 [1988] In pigs, respiratory diseases1706 [1989] such as chronic pleuritis and pneumonia have been strongly correlated to increased crowding of pigs per pen1707 [1990] and per building,1708 [1991] corresponding to increased levels of bacteria cultured right out of the air.1709 [1992] In 1918, Army regiments whose barracks allowed only 45 square feet per soldier had a flu incidence up to ten times that of regiments afforded 78 square feet per man.1710 [1993] Not only does increased poultry density enable the enhanced spread of bird flu, but WebsterR17;s group considers it a R20;big factorR21; in the rise of highly pathogenic viruses in the first place. The R20;more hosts in close confinements,R21; the more easily the virus can mutate into a form capable of infecting humans and eventually spreading throughout the human population.1711 [1994] The more animals there are to easily jump between, the more spins the virus may get at the roulette wheel gambling for the pandemic jackpot that may be hidden in the lining of the chickensR17; lungs. Research on the evolution of antibiotic resistance, for example, has shown that R20;intensive productionR21; can R20;vastly increase the occurrence of very rare genetic events.R21;1712 [1995] Influenza viruses donR17;t just need to proliferate; they need to evolve. In land-based birds, it is advantageous for influenza viruses to switch from residing peacefully in the intestine to invading the respiratory tract, from being spread only through the water to also being spread through the air. To adapt, the virus must first survive by overwhelming host defenses. As shown in earlier examples, when animals are spread apart, the virus is presumably constrained by needing to keep the host healthy enough, long enough, to spread to another. Under extreme crowding conditions, though, natural biological checks and balances on virulence may no longer apply. Anthropologist and author Wendy Orent explained this in the Los Angeles Times: H5N1 has evolved great virulence among chickens only because of the conditions under which the animals are keptR12;crammed together in cages, packed into giant warehouses. H5N1 was originally a mild virus found in migrating ducks; if it killed its host immediately, it too would die. But when its next hostR17;s beak is just an inch away, the virus can evolve to kill quickly and still survive.1713 [1996] With tens if not hundreds of thousands of susceptible hosts crammed beak-to-beak, the virus can rapidly cycle from one bird to the next, accumulating adaptive mutations. With so many teachers, the virus may learn at an accelerated rate. French scientist C.J. Davaine was one of the first to demonstrate the concept of R20;serial passage.R21; How much anthrax-infected blood, he wondered, would it take to kill a rabbit? Davaine showed that it took ten drops of blood swarming with anthrax to infect and kill a rabbit. Fewer than ten drops and the rabbit survived. But, when he took blood from the first rabbit and infected another, the second required a smaller infectious dose. The anthrax germ was learning. Passing from rabbit to rabbit, the anthrax adapted to its new host to become more and more deadly. By the fifth rabbit, instead of requiring ten drops to kill the rabbit, it only took 1/100th of one drop to kill. By the 15th passage the pathogen became so well adapted that it only took 1/40,000th of a single drop. After passing through 25 rabbits, just one-millionth of a drop could be fatal. When a pathogen passes into a new environment, species, or even host, it may start out with low pathogenicity. But, when it passes from animal to animal, it can learn to become a more proficient killer.1714 [1997] Forget 25 hosts: broiler chicken sheds offer an average of 25,000 captive hosts, and some egg-laying hen sheds 250,000.1715 [1998] Once the virus burns through a chicken shed, its survival is again jeopardizedR12;unless it can find new victims. Depending on the ambient conditions, influenza virus can only endure in wet manure for weeks at most.1716 [1999] The virus no longer has the luxury of being sheltered for months, lurking in the depths of some Canadian lake. It has very little time to find its way into another flock, so the virus hitches a ride on whatever it can find: footwear, clothing, tires, trucks, cages, crates, insects, rodents, or even the wind, blown out into the countryside by the colossal fans that ventilate the sheds. Mink fur farms are crowded enough to suffer influenza outbreaks, but unless there are multiple farms to which the virus can travel, the virus seems to inevitably fizzle out.1717 [2000] When spatial analyses were carried out of the spread of H5N1 in Asia, outbreaks corresponded to areas with the greatest numbers of chickens per square mile. When researchers overlaid a poultry density map of a country on a map of outbreaks, the maps lined up with statistical significance.1718 [2001] So, within a shed, on a farm, or even across an entire region, as the WHOR17;s Asian director put it, R20;outbreaks of avian influenza correspond to where [poultry] population density is very high.R21;1719 [2002] Large, crowded populations may be the only way a short-lived virus like influenza has been able to exist for millions of years. Viruses tend to have one of two R20;viral life strategies.R21;1720 [2003] There are persistent viruses like herpes, which have survived through the ages because they can hide within the body, only peeking out for a transient blistering rash in order to spread before going back underground to hide from the bodyR17;s defenses. Then there are the acute viruses like influenza, which have no place to hide. They only have a matter of days to spread before they kill the host or, more likely, the host kills them. Therefore, without a vast, dense population of susceptible hosts, the virus would quickly disappear. Even in wild waterfowl, influenza is transient. There is no evidence that ducks carry the virus for more than a few weeks at a time, so the virus seems to rely on the fact that for 100 million years, aquatic birds like ducks and geese have gathered in mass congregations. Combined with efficient waterborne transmission, this rather unique circumstance of a densely crowded yet mobile population makes waterfowl essentially the only host in the animal kingdom thought able to continuously support such a short-lived infection.1721 [2004] In 1989, a bird flu virus jumped straight into horses in China, killed 20% of a herd, and then quickly disappeared.1722 [2005] Such epidemics seem necessarily self-limited since the population is restricted in size and not rapidly replenished with new hosts.1723 [2006] Unless we start circulating tens of thousands of horses through crowded megabarns, horse flu has little chance of taking root and, presumably, even less chance of posing a human threat. Only, perhaps, when the poultry population and density reached a critical massR12;and one that was continuously repopulatedR12;could chickens act as harbingers of viruses like H5N1.1724 [2007] Similar studies on influenza in commercial pig operations have come to the same conclusion. An increased density of pigs per pen, pigs per operation, and pigs per municipality all have been shown to be associated with increased risk of swine flu infection.1725 [2008] Whether talking about pigs in a shed or sniffly kids in a preschool, the greater the number of contacts, the greater the risk of spread. Pig farm researchers blame the increased risk in part on diminished air volume per animal, increasing the concentration of infectious particles and thereby facilitating aerosol spread.1726 [2009] ItR17;s like a pig sneezing in one really big crowded elevator. A professor of Medical Microbiology at the University of Edinburgh concluded that R20;overcrowded farms are a hotbed of genetic mixing for flu viruses.R21;1727 [2010] (c) BirdFluBook.com | Home [2011] | Website by Lantern Media [2012] Bird Flu - Stressful BirdFluBook.com [2013] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2014] Stressful Beak "trimming" Overcrowding may also increase the vulnerability for each individual animal. Frederick Murphy, dean emeritus of the School of Veterinary Medicine at the University of CaliforniaR11;Davis, has noted how these changes in the way we now raise animals for food R20;often allow pathogens to enter the food chain at its source and to flourish, largely because of stress-related factors.R21;1728 [2015] The physiological stress created by crowded confinement can have a R20;profoundR21; impact on immunity,1729 [2016] predisposing animals to infection.1730 [2017] Diminished immune function means diminished protective responses to vaccinations. R20;As vaccinal immunity is compromised by factors such asR30;immunosuppressive stress,R21; writes a leading1731 [2018] USDA expert on chicken vaccines, R20;mutant clones have an increased opportunity to selectively multiply and to be seeded in the environment.R21;1732 [2019] Studies exposing birds to stressful housing conditions provide R20;solid evidence in support of the concept that stress impairs adaptive immunity in chicken.R21;1733 [2020] Chickens placed in overcrowded pens develop, over time, R20;increased adrenal weightR21;R12;a swelling growth of the glands that produce stress hormones like adrenalineR12;while, at the same time, experiencing R20;regression of lymphatic organs,R21; a shriveling of the organs of the immune system.1734 [2021] This is thought to demonstrate a metabolic trade-off in which energies invested in host defense are diverted by the stress response,1735 [2022] which can result in R20;extensive immunosuppression.R21;1736 [2023] EuropeR17;s Scientific Veterinary Committee reported that one of the reasons Europe is phasing out battery cages for egg-laying hens is that evidence suggests caged chickens may have higher rates of infections R20;as the stresses from being caged compromise immune function.R21;1737 [2024] Leading meat industry consultant Temple Grandin, an animal scientist at Colorado State University, described the stresses of battery-cage life in an address to the National Institute of Animal Agriculture. R20;When I visited a large egg layer operation and saw old hens that had reached the end of their productive life, I was horrified. Egg layers bred for maximum egg productionR30;were nervous wrecks that had beaten off half their feathers by constant flapping against the cage.R21;1738 [2025] Referring to egg industry practices in general, Grandin noted, R20;ItR17;s a case of bad becoming normal.R21;1739 [2026] Under intensive confinement conditions, not only may the birds be unable to comfortably turn around or even stand freely, but the most basic of natural behaviors such as feather preening may be frustrated, leading to additional stress.1740 [2027] Overcrowding may disrupt the birdsR17; natural pecking order, imposing a social stress that has been shown for more than 30 years to weaken resistance to viral infection1741 [2028] and, more recently, a multitude of other disease challenges.1742 [2029] Industry specialists concede it R20;provenR21; that R20;high stress levels, like the ones modern management practices provoke,R21; lead to a reduced immune response.1743 [2030] Breeding sows are typically confined in metal stalls or crates so narrow they canR17;t turn around. Prevented from performing normal maternal behavior (and, clearly, physical behavior), the pigs produce lower levels of antibodies in response to an experimental challenge.1744 [2031] R20;Forget the pig is an animal,R21; an industry journal declared decades ago. R20;Treat him just like a machine in a factory.R21;1745 [2032] Measures as simple as providing straw bedding for pigs may improve immune function. R20;Studies suggest,R21; reads a 2005 review, R20;that the stress of lying on bare concrete may reduce resistance to respiratory disease leading to increased infection risk.R21;1746 [2033] German researchers found specifically that straw bedding was linked to decreased risk of infection with the influenza virus.1747 [2034] Another source of stress for many birds raised for meat and eggs is the wide variety of mutilations they may endure. Bits of body parts of unanesthetized birdsR12;such as their combs, their spurs, and their clawsR12;can be cut off to limit the damage of often stress-induced aggression. Sometimes, toes are snipped off at the first knuckle for identification purposes.1748 [2035] University of Georgia poultry scientist Bruce Webster described the broiler chicken at an American Meat Institute conference as R20;essentially an overgrown baby bird, easily hurt, sometimes treated like bowling balls.R21;1749 [2036] Most egg laying hens in the United States are R20;beak-trimmed.R21;1750 [2037] Parts of baby chicksR17; beaks are sliced off with a hot blade, an acutely painful1751 [2038] procedure shown to impair their ability to grasp and swallow feed.1752 [2039] Already banned in some European countries as unnecessary,1753 [2040] the procedure is viewed by some poultry scientists as no more than a R20;stop-gap measure masking basic inadequacies in environment or management.R21;1754 [2041] A National Defense University Policy Paper on agricultural bioterrorism specifically cited mutilations in addition to crowding as factors that increase stress levels to a point at which the resultant immunosuppression may play a part in making U.S. animal agriculture vulnerable to terrorist attack.1755 [2042] Ian Duncan just stepped down as University of Guelph Animal and Poultry Science Department University Chair. He has been outspoken about the animal and human health implications of these stressful practices. R20;All these R16;elective surgeriesR17; involve pain,R21; Duncan writes, R20;perhaps chronic pain. No anesthetic is ever given to the birds. These mutilations are crude solutions to the problems created by modern methods of raising chickens and turkeys.R21;1756 [2043] The former head of the Department of Poultry Science at North Carolina State University describes how turkeys start out their lives. Newborn turkey chicks are: squeezed, thrown down a slide onto a treadmill, someone picks them up and pulls the snood off their heads, clips three toes off each foot, debeaks them, puts them on another conveyer belt that delivers them to another carousel where they get a power injection, usually of an antibiotic, that whacks them in the back of their necks. Essentially, they have been through major surgery. They have been traumatized.1757 [2044] Research performed at the University of ArkansasR17; Center of Excellence for Poultry Science suggests that the cumulative effect of multiple stressors throughout turkey production results in conditions like R20;turkey osteomyelitis complex,R21; where decreased resistance to infection leads to a bacterial invasion into the bone, causing the formation of abscessed pockets of pus throughout the birdsR17; skeletons. USDA researchers blame R20;stress-induced immunosuppressionR21; in turkeys on their R20;respon[se] to the stressors of modern poultry production in a detrimental manner.R21;1758 [2045] The stress of catching and transport alone has been shown to induce the disease.1759 [2046] If modern production methods make animals so vulnerable to illness, why do they continue? The industry could reduce overcrowding, thereby lowering mortality losses from disease, but, as poultry scientists explain, R20;improving management may not be justified by the production losses.R21;1760 [2047] In other words, even if many birds die due to disease, the current system may still be more profitable in the short run. R20;Poultry are the most cost-driven of all the animal production systems,R21; reads one veterinary textbook, R20;and the least expensive methods of disease control are used.R21;1761 [2048] It may be cheaper to just add antibiotics to the feed than it is to make substantive changes, but relying on the antibiotic crutch helps foster antibiotic-resistant superbugs and does nothing to stop bird flu. The leading poultry production manual explains the economic rationale for overcrowding: R20;[L]imiting the floor space gives poorer results on a bird basis, yet the question has always been and continues to be: What is the least amount of floor space necessary per bird to produce the greatest return on investment.R21;1762 [2049] What remains missing from these calculations is the cost in human lives, which for poultry diseases like bird flu, could potentially run into the millions. (c) BirdFluBook.com | Home [2050] | Website by Lantern Media [2051] Bird Flu - Filthy BirdFluBook.com [2052] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2053] Filthy Battery caged hens from below In intensive confinement production, crowding, stress, and filth go hand in hand in hand. The USDA points out that a single gram of manure (approximately the weight of a paper clip) from an infected chicken can contain R20;enough virus to infect 1 million birds.R21;1763 [2054] A 20,000-bird broiler flock produces more than a ton of droppings every day.1764 [2055] They are literally sitting in it. By the end of their lives, many of the birds can no longer stand. R20;The birds are bred for such size that their legs become so weak that they often cannot support the weight of their bodies,R21; explains a USDA poultry specialist. R20;They therefore spend much of the time squatting on the floor in the litter.R21;1765 [2056] ThatR17;s where they eat, sleep, and defecate. At just six weeks old, meat-type chickens are so heavy and the stress on their hips and legs so great that they spend more than three-quarters of their time lying in their own waste.1766 [2057] Leading industry consultant Temple Grandin writes: R20;TodayR17;s poultry chicken has been bred to grow so rapidly that its legs can collapse under the weight of its ballooning body. ItR17;s awful.R21;1767 [2058] By the time they are slaughtered, all of their carcasses will show evidence of gross fecal contamination.1768 [2059] Small wonder modern poultry products represent such prime carriers of foodborne illness,1769 [2060] especially since, unlike with cows and pigs, the skin can be eaten with the meat.1770 [2061] The putrefying feces generate several irritating chemicals, including hydrogen sulfide (the R20;rotten eggR21; gas), methane, and ammonia.1771 [2062] R20;Ammonia in a poultry house is nauseating to the caretaker, irritates the eyes, and affects the chickens,R21; states one poultry science textbook.1772 [2063] Given the extreme stocking density, the litter can get so saturated with excrement that birds may develop sores or R20;ammonia burnsR21; on their skin, known as breast blisters, hock burns, and footpad dermatitis, all of which have become significantly more common and serious over the last 30 years.1773 [2064] The ammonia burns the birdsR17; eyes and lungs as well. Studies have shown that high levels of ammonia increase the severity of respiratory disorders like pneumonia1774 [2065] in part by directly damaging the respiratory tract, predisposing them to infection.1775 [2066] A massive study involving millions of birds from nearly 100 commercial farms across multiple countries found that ammonia levels increased the excretion of the stress hormone corticosteroid, a potent immune depressant.1776 [2067] Besides the role chronic irritative stress plays, ammonia also directly suppresses the immune system. Ammonia gets absorbed into the birdsR17; bloodstreams, where it interferes with the action of individual white blood immune cells.1777 [2068] Although airborne aerosol spread of H5N1 remains relatively inefficient, even among birds,1778 [2069] the ammonia damage associated with intensive poultry production may facilitate the virus acquiring so-called pneumotropic, or R20;lung-seeking,R21; behavior.1779 [2070] The air within industrial broiler chicken sheds is thick with fecal dust, presumably making disease spread effortless for the influenza virus. Increased stocking density leads to high concentrations of aerial pollutants, which then leads to increased respiratory disease challenge to the birdsR17; immune systems.1780 [2071] In addition to fecal material, the airborne dust in such facilities has been found to contain bacteria, bacterial toxins, viruses, molds, nasal discharge, feather and skin debris, feed particles, and insect parts.1781 [2072] Poultry confinement buildings can average more than a million bacteria floating in every cubic yard of air.1782 [2073] In addition to adding to airway irritation, these dust particles clog up the birdsR17; lungs, overwhelming the lungsR17; clearance mechanisms. Researchers demonstrated decades ago that exposing a chick to a normally harmless strain of E. coli in an environment clouded with dust or ammonia can cause disease.1783 [2074] The very air birds breathe in intensive confinement may predispose them to infection with influenza. Every day, in every shed, another ton of droppings is dropped. In the United States, meat-type chickens are slaughtered at about 45 days and a new flock of chicks is brought in from the hatchery. Unbelievably, the broiler sheds may not be cleaned between flocks. So new hatchling chicks are placed directly on the tons of feces that have already been layered down, and the cycle continues. R20;European growers visiting U.S. production facilities inevitably find this practice shocking,R21; admits poultry specialist Frank Jones at the Department of Poultry Science at North Carolina State University. Veterinary experts have also been critical of this practice. As specified in the journal of the World Organization for Animal Health, fecal waste should be removed from the shed before adding a new flock.1784 [2075] The UN Food and Agriculture Organization agrees the dirty litter should be removed.1785 [2076] Placing day-old chicks in sheds contaminated with R20;built-upR21; litter is said to expose the birds to R20;a wide range of poultry pathogens.R21;1786 [2077] The Advisory Committee on the Microbiological Safety of Food reported that the most significant source of Campylobacter infection in chickensR12;infection that goes on to sicken millions of Americans1787 [2078] R12;is R20;the environment of the industrial broiler house.R21;1788 [2079] The poultry industry suspects that R20;general farm hygiene could reduce the numbers [of Campylobacter bacteria-contaminated carcasses] by around 40%.R21; A R20;zero toleranceR21; policy is impractical, the industry emphasizes, R20;because it is impossible to achieve at reasonable costR30;.R21;1789 [2080] Leaving the caked layer of fecal material is another example of R20;least cost production,R21; not least risk. Low-cost poultry housing means dirt floors.1790 [2081] Every time the shed is cleaned, some of the dirt is scraped up, eventually requiring replacement with more dirt. Concrete floors are easier to clean more frequently, but are more expensive. R20;WeR17;re really locked into the system weR17;ve got,R21; Jones says. R20;It would cost dearly to change it now.R21; In a specially commissioned feature on preventing disease to celebrate Poultry InternationalR17;s 40-year publishing history, the trade magazine noted: R20;Replacing used litter between flocks is a standard practice worldwide, but it will not gain acceptance in the United States.R21; The investment would evidently not be worth the return. R20;[U]nless federal regulations force drastic changes,R21; the article concluded, R20;nothing spectacular should be expected.R21;1791 [2082] (c) BirdFluBook.com | Home [2083] | Website by Lantern Media [2084] Bird Flu - Lack of Sunlight BirdFluBook.com [2085] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2086] Lack of Sunlight When the poultry sheds are eventually scooped out, some of the scrapingsR12;about one million tons per yearR12;are fed to American cattle,1792 [2087] and some are spread upon cropland as fertilizer. Out in the open air, combined with the sanitizing rays of the sun, the tons of manure rapidly dry and the fecal micro-organism rapidly die.1793 [2088] Inside dimly lit sheds, however, human pathogens like Salmonella1794 [2089] and Campylobacter1795 [2090] thrive in the moist litter. So may viruses like H5N1. Transmission experiments with chickens reveal that the spread of H5N1 is predominantly via the fecal-oral route rather than in respiratory droplets. H5N1 can survive in wet feces for weeks, but at ambient temperatures is inactivated as soon as the feces dry out.1796 [2091] In an outdoor, free-range setting, then, the spread of bird flu viruses like H5N1 would be expected to be relatively inefficient. In countries like Thailand, the combination of tropical heat and crowded confinement necessitates R20;evaporative coolingR21; in poultry sheds, which uses large fans and a water mist to cool down the birds during the hot season. Although this reduces heat stress, the high level of humidity ensures that the litter is kept moist, which may facilitate the spread of pathogens like bird flu. So-called R20;evap housesR21; increase flock survival, but may increase virus survival as well.1797 [2092] Farther north in China, some poultry flocks may be outdoors most of the year but taken inside during the cold winter months, offering researchers a unique opportunity to compare bird flu activity in flocks confined indoors versus those let outside. Indeed, bird flu outbreaks are more likely to occur when the birds are crammed inside. Although this may be due to other factors, such as increased viral survival at colder temperatures, the FAO blames in part the winter confinement.1798 [2093] Increased crowding indoors with suboptimal ventilation,1799 [2094] combined with less solar radiation across the EarthR17;s surface,1800 [2095] may be why the human flu season flips every year between the north and south hemispheres following the winter. R20;Birds that are housed indoors year-round should be considered more susceptible to infectious diseases,R21; an avian virus textbook reads, R20;because of decreased air quality, the accumulation of pathogens in a restricted environment, and the lack of exposure to sunlight. These factors function collectively to decrease a birdR17;s natural resistance to disease.R21;1801 [2096] The absence of adequate ventilation and sunlight inherent to intensive confinement is a powerful combination for the spread of influenza. Perhaps the best studied illustration of the danger of crowded enclosed spaces in human medicine was a commercial airline flight in 1977 that was stuck on a tarmac for more than four hours due to a mechanical failureR12;while a young woman lay prostrate in the back of the cabin feverishly coughing with the flu. Within three days, nearly three out of four of the remaining passengers were destined to share in her pain.1802 [2097] Laboratory studies on animals show the same thingR12;decreased air exchange is strongly associated with increased influenza infection rate.1803 [2098] Lessons can be learned from past pandemics. In 1918, as Boston hospitals filled beyond capacity, a tent hospital was set up in nearby Brookline. Though exposing ailing patients to the chilly Boston autumn was condemned by Bostonians as R20;barbarous and cruel,R21; it turned out that the fresh breeze and sunshine seemed to afford the lucky overflow patients far better odds of survival than those inside the overcrowded, poorly ventilated hospitals.1804 [2099] A study of the 1957R11;58 pandemic demonstrated the potential role of sunlight. Ultraviolet rays damage genetic material. ThatR17;s why we get a sunburn: The ultraviolet light in the sunR17;s rays damages DNA in our skin, triggering the inflammation that manifests as redness and pain.1805 [2100] Ultraviolet lights, then, have been used in tuberculosis wards to kill off some of the TB bugs coughed into the air. To see if influenza could be killed in the same way, researchers compared influenza rates in patients in TB buildings with UV lights to patients in TB buildings without UV lights during the pandemic. In the rooms without UV, 19% got the flu; in rooms with the UV lights only 2% became infected, a statistically significant difference.1806 [2101] This suggests that sunlight may help sanitize influenza virus from the air, highlighting the increased risk of crowding poultry indoors. For flocks raised outdoors, according to the FAO, the natural UV rays of the sun may R20;destroy any residual virus.R21;1807 [2102] If sunlight has such a disinfectant quality, why doesnR17;t the industry install windows to allow some natural sunlight to perhaps cut down on airborne fecal pollutants? More light means chickens become more active, which means, as one poultry industry trade journal describes, R20;birds burn energy on activity rather than on growth and development.R21; Natural lighting has a negative impact on R20;feed conversion.R21;1808 [2103] In other words, the animals R20;wasteR21; energy on moving instead of just growing fatter to reach slaughter weight faster. According to Broiler Industry, R20;It is obvious that the light supplied by sunshine during the day and normal darkness at night is the most inferior of any lighting program.R21;1809 [2104] (c) BirdFluBook.com | Home [2105] | Website by Lantern Media [2106] Bird Flu - Bred to Be Sick BirdFluBook.com [2107] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2108] Bred to Be Sick Unnatural growth rates can lead to crippling deformities According to a textbook on avian virology, R20;Viral infections can move fastest through groups of birds maintained in closed, crowded, unsanitary conditions.R21;1810 [2109] Under such conditions, even healthy immune systems might be overwhelmed, but immune competence among modern poultry breeds may be at an all-time low. Breeding for production traits, like increased breast muscle in meat-type birds or increased egg-laying in egg breeds, seems to necessarily mean breeding for decreased immune function. Given the intensive breeding-out of immune functionality, almost all modern commercial chickens may be R20;physically compromisedR21; in a way that would facilitate wild waterfowl viruses taking hold. R20;[D]omestic poultry have been bred to be plump and succulent rather than disease-resistant,R21; a senior virologist at the Australian Animal Health Laboratory points out. R20;[T]heyR17;re sitting ducks, so to speak, for their wild cousinsR17; viruses.R21;1811 [2110] It wasnR17;t until well into the 20th century that the poultry industry began segregating chicken breedsR12;some for meat and others for eggs.1812 [2111] Once maximum productivity became the emphasis, these two traits became mutually exclusive. For broilers, R20;meat output per chickR21; is considered the most important goal,1813 [2112] so the bigger the better.1814 [2113] In contrast, the industry wants laying hens to be small. Big eggs from small bodies ensures that more of the feed goes into the egg rather than being R20;wastedR21; on the upkeep of the rest of the animal.1815 [2114] In the egg industry, R20;feed conversion,R21; the conversion of feed into eggs, is considered the trait with the single biggest R20;impact on profitability.R21; Modern egg-laying hens are bred to be so scrawny that itR17;s not profitable to raise male chicks for meat. Since they canR17;t lay eggs, male chicks are an unwanted by-product of the industry. It makes more economic sense to kill the male chicks shortly after hatching by the hundreds of millions1816 [2115] R12;grinding them up alive, gassing them, or throwing them into a dumpster to suffocate or dehydrate1817 [2116] R12;than to waste feed on them.1818 [2117] So, in the interest of maximizing productivity, two different lines of chickens were created, one for meat and another for eggs. As one historian noted, by the end of the 1950s, the R20;era of the designer chickenR21; had arrived.1819 [2118] The results have been extraordinary. Selective breeding over time is, after all, what turned the wolf into a poodle. Ancestors to the modern-day chicken laid only about 25 eggs a year.1820 [2119] TodayR17;s laying hens produce more than ten times that number,1821 [2120] leading to increasing problems with uterine prolapse1822 [2121] and broken bones due to critical weakening, as skeletal calcium is mobilized to form shells for the eggs.1823 [2122] The R20;essenceR21;1824 [2123] of broiler chicken production, as poultry scientists describe it, is R20;turning feed stuffs into meat.R21;1825 [2124] Chicken ancestors grew to be about two pounds in four months.1826 [2125] In the 1950s the industry could raise a five-pound chicken in less than three months. Due mostly to selective breeding (in addition to growth-promoting drugs), this now takes an average of 45 days.1827 [2126] Broiler chickens now grow more than twice as large in less than half the time. To put the growth rate of todayR17;s broiler chickens into perspective, the University of Arkansas Division of Agriculture reports, R20;If you grew as fast as a chicken, youR17;d weigh 349 pounds at age two.R21;1828 [2127] In one century, as one historian relates, R20;the barnyard chicken was made over into a highly efficient machine for converting feed grains into cheap animal-flesh protein.R21;1829 [2128] Interestingly, this transformation in chickens was considered such an R20;outstanding example of the contribution of breeding workR21;1830 [2129] that many of the earliest poultry scientists helped form the American BreedersR17; Association,1831 [2130] which went on to lead the human eugenics movement.1832 [2131] Leading U.S. poultry scientist and eugenics pioneer Charles B. Davenport spoke of poultry breeding efforts as akin to R20;race improvementR21;1833 [2132] and R20;purification.R21;1834 [2133] Likewise, Heinrich HimmlerR17;s experience with chicken breeding has been noted for having shaped his views on the subject.1835 [2134] The R20;improvementR21; of poultry over the last century has been deemed R20;quite profitable,R21;1836 [2135] but the industry admits to the downsides. The current editor of industry trade journals WATT PoultryUSA and the Poultry Tribune wrote, R20;Ongoing efforts to increase breast-meat yield, for example, have created a higher propensity for musculoskeletal problems, metabolic disease, immunodeficiency, and male infertility, primarily because the extra protein going to breast muscle production comes at the expense of internal organ development.R21;1837 [2136] TodayR17;s broiler chickens grow so fast that they outpace their cardiovascular systemR17;s ability to keep up, leading to forms of heart failure like Sudden Death Syndrome (also known as R20;flip-over syndromeR21;). Heart failure is an increasingly1838 [2137] major1839 [2138] cause of mortality among commercial flocks, even though the birds are only a few weeks old. An industry journal reports that R20;broilers now grow so rapidly that the heart and lungs are not developed well enough to support the remainder of the body, resulting in congestive heart failure and tremendous death losses.R21;1840 [2139] Mortality rates of broilers are up to seven times that of chickens not bred for fast growth.1841 [2140] This tradeoff is accepted if the increased mortality is compensated for by an increase in meat yield or feed conversion. To maximize profits, commercial broiler producers now accept a mortality rate of 5%.1842 [2141] Chickens arenR17;t dying just because their circulatory systems are collapsing under the strain. Chickens bred for unnaturally developed muscles (meat) have unnaturally underdeveloped immune systems. Broiler chickens selected for accelerated growth suffer from weakened immunity, which increases mortality1843 [2142] by making them R20;more susceptible to a variety of infectious diseases.R21;1844 [2143] When you breed for one characteristic, you may lose another. The modern tomato, for example, may be perfectly round and survive to market less bruised, but it also may be tough, pink, and tasteless compared to heirloom varieties. Just as purebred poodles tend to have problems with their hips, modern-day purebred chickens tend to have problems with their immune systems. Even excluding heart failure, studies show that the highest mortality is seen in the fastest-growing chickens, and the lowest mortality in the slowest-growing chickens. Researchers conclude, R20;It appears that broilers with faster growth rate are under physiological and immunological stress that makes them more sensitive to infectious diseasesR30;.R21;1845 [2144] This has been shown for both viral1846 [2145] and bacterial1847 [2146] pathogens. In one study, broilers were intentionally infected with E. coli: 40% of the fast-growing heavier birds died, compared to only 8% to 20% mortality for slower-growing breeds. The scientists commented, R20;These results indicate that rapid growth rate substantially reduces broiler viability.R21;1848 [2147] Research with turkeys shows the same thing, despite the president of the National Turkey FederationR17;s claim that R20;[r]ealty [sic] is that in this country the poultry industry treats the health of the birds as the number one issue.R21;1849 [2148] Lighter and slower-growing turkey breeds than those conventionally used have better immune performance1850 [2149] and are hence more resistant to stress1851 [2150] and disease.1852 [2151] Researchers have observed that in natural outbreaks of disease like fowl cholera,1853 [2152] turkeys bred for increased egg production and those selected for increased body weight had significantly higher mortality rates.1854 [2153] Slower-growing, lighter breeds of turkeys also have greater adaptability to the stresses associated with production, such as overcrowding.1855 [2154] USDA researchers at the University of Arkansas went so far as to suggest in a 2005 paper in Poultry Science that R20;fast growth in modern turkey linesR21; may result in stress responses R20;incompatible with the severe stressors that sometimes occur during commercial poultry production.R21;1856 [2155] The turkey industry has so altered the natural order that the enormous breast meat mass of commercial breeds has resulted in the birds being physically incapable of mating.1857 [2156] R20;One hundred percent artificial insemination,R21; researchers note in Livestock Production Science, R20;allowed for the continuation of intense selection for body weight in male lines.R21;1858 [2157] Female turkeys are inseminated by tube or syringe.1859 [2158] Selection has been so intense that commercial turkeys, like broiler chickens, can barely support their own weight. A staff editor of the leading U.S. livestock feed industry publication writes that R20;turkeys have been bred to grow faster and heavier but their skeletons havenR17;t kept pace, which causes R16;cowboy legs.R17; Commonly, the turkeys have problems standingR30;and fall and are trampled on or seek refuge under feeders, leading to bruises and downgradings as well as culled or killed birds.R21;1860 [2159] One group of researchers concluded, R20;We consider that birds might have been bred to grow so fast that they are on the verge of structural collapse.R21;1861 [2160] Many do collapse and spend much of their time lying in their own waste. Similar to broiler chickens, most turkeys in commercial production are overcrowded in warehouse-like sheds, and the majority1862 [2161] suffer from ulcerative contact dermatitis, from breast blisters to bed sore-like hock burns.1863 [2162] These painful lesions add to the stress that may impair overall immune performance. USDA researchers conclude: R20;Selection of poultry for fast growth rate is often accompanied by a reduction in specific immune responses or increased disease susceptibility.R21;1864 [2163] Slower growth is costly, but so are disease outbreaks. Why doesnR17;t the industry select for birds with improved immune responses? TheyR17;ve tried. Early in the industryR17;s history, rather crude methods were used to try to breed for resistance. Breeders would take baby chicks and challenge their immune systems by exposing them to adults with MarekR17;s disease, a poultry disease caused by a cancer-causing herpes virus. Those who lived through the exposure went on to create the next generation, one that would presumably be more resistant to the disease.1865 [2164] No one wants to bite into a tumor at KFC. Sometimes the chicks didnR17;t get infected by casual exposure, though. Breeders found that by dripping virus-laden blood from infected chickens into the eyes of baby chicks, they were able to guarantee infection, but this produced mortality rates between 30% and 60%. It was not considered economical to kill more than half the chicks. R20;Challenge by intraperitoneal injection of whole blood or suspensions of fresh tumorous gonads from clinically sick birds was also tested,R21; poultry scientists report, R20;but later discontinued because the mortality rates exceeded the optimum of 50%R30;.R21; The intent was to kill off half the chicks, but injecting ground-up tumorous sex organs into the abdomens of baby chicks turned out to be a little too fatal.1866 [2165] Challenge tests continue in poultry bree1867ding, but on a much smaller scale. This kind of direct selection is considered R20;inconvenientR21; in intensive production systems due to the costs involved.1868 [2166] Breeders have tried selecting for antibody response directly, but poultry scientists have found that those with the best antibody responses consistently had significantly lower weights at all ages.1869 [2167] Research dating back 30 years shows that chickens bred to be disease-resistant have lower body weight and produce smaller eggs.1870 [2168] Studies suggest that immune defects may actually enhance poultry performance.1871 [2169] Seems like you can have one or the other, immunity or growth. And the industry chooses growth. This happens across species. Growth and disease susceptibility have been shown to go hand-in-hand in pigs,1872 [2170] cattle,1873 [2171] and dairy cows. Over the past century, genetic manipulation of dairy cows through selective breeding has tripled the annual milk yield to 18,000 pounds of milk per cow. It took the first half of the century to force the first ton increase, but since the 1980s, the industry has managed to add extra tons every eight or nine years.1874 [2172] Turning cows into milk factories has taken a toll on their immune systems,1875 [2173] increasing their risk of mastitis,1876 [2174] infections of the udder. Mastitis may be painful for the animal and spike the milk supply with increasing levels of somatic (pus) cells, but decreased cow immunity, as opposed to decreased chicken immunity, is unlikely to aid and abet in the killing of millions of people. Why is immunity reduced when production is maximized? Our best understanding is the R20;resource allocation theory.R21; There is only a certain amount of energy, protein, and other nutrients coming into an animalR17;s system at any one time. Those resources can go to build muscle or to host defense, like a national budget in which money is divided between the countryR17;s infrastructure and homeland security. So dairy cows, for example, have been bred to R20;redirect resources from the maintenance of an adequate immune system to milk production in order to maintain advantages in milk yield,R21; reads one dairy science textbook.1877 [2175] This is a trade-off between production traits and immunocompetence.1878 [2176] Studies show that old-fashioned, slower-growing chicken breeds have larger1879 [2177] and better developed1880 [2178] antibody-producing immune organs. Instead of being bred to transfer the bulk of resources to build breast meat while neglecting other needs, these slower-growing breeds had sufficient resources to foster a more functional antibody response system.1881 [2179] Antibodies are critically important for vaccine effectiveness, particularly in animals like broiler chickens who are killed after only a handful of weeks of life and donR17;t have time to acquire a set of their own immune memories. R20;Those animals which are intensively reared and slaughtered young,R21; notes one agricultural microbiologist, R20;will have the greatest potential for carrying pathogens.R21;1882 [2180] One of the reasons that 1% to 4% of broilers die from R20;acute death syndromeR21;1883 [2181] (in which chickens suddenly lose their balance, violently flap their wings, go into spasms, and die of acute heart failure) is that the metabolic demand for oxygen created by the increasing muscle mass leaves the rest of their body short of oxygen.1884 [2182] Forget immunityR12;many modern broiler chickens can hardly keep up with breathing. Meat-type birds outgrow their lungs, hearts, and immune systems. The maintenance of an effective immune system is metabolically very costly.1885 [2183] The R20;big eaterR21; macrophage immune cells burn through almost as much energy as maximally functioning heart muscle.1886 [2184] Antibodies are made out of protein. When the body is churning out thousands of antibodies per second, there is less protein available for growth. Studies show that chickens capable of mounting a decent antibody response have lower weight and lower weight gain than chickens with suboptimal antibody production.1887 [2185] Germ-free chicks raised in germ-free environments grow faster than chickens in unsanitary environments.1888 [2186] Even minute exposures to the normal microbial flora of the gut are enough of an immune stimulus to significantly reduce growth rates.1889 [2187] Though thereR17;s no tissue damage and no evidence of disease, just the normal day-to-day functioning of the immune system diverts energy from maximal growth.1890 [2188] ThatR17;s why you can feed germ-free chickens in a sanitary laboratory environment all the antibiotics you want and there will be no change in growth rates, whereas commercially confined chickens fed antibiotics demonstrate a remarkable spurt in growth.1891 [2189] By breeding for maximum production, the industry seems to be breeding for minimum immunity. The reason that selecting for growth impairs immunity is the same reason that human AIDS and tuberculosis patients waste away. Fighting off infection requires a remarkable demand for energy and nutrients. The body shifts resources away from nonessential anabolic (meaning growth, as in R20;anabolic steroidsR21;) and maintenance processes toward bolstering life-or-death defenses.1892 [2190] This redistribution of resources makes sense from an evolutionary point of view. What use is long-term growth when short-term survival is threatened? Not only are the bodyR17;s construction projects halted, but they start to be torn down for raw materials. People with severe infections can lose up to one-third of their body weight as the body starts eating away at itself to feed more fuel into the immune machine.1893 [2191] Even relatively insignificant challenges to the immune system can significantly affect growth. Simple vaccinations can result in a greater than 20% decline in daily weight gain for farm animals and increase protein demands as much as 30%,1894 [2192] demonstrating the perverse balance between growth and immunity. The poultry industry canR17;t have it both ways. Before domestication, natural selection chose strong immune systems for survival.1895 [2193] After domestication, though, R20;[a]rtificial selection concentrated on improvement of production traits with little attention to resistance to disease,R21;1896 [2194] reads one poultry breeding textbook. The industry seems more interested in the survival of the fattest, not the fittest.1897 [2195] Animals are preprogrammed by evolution to grow at the near optimal rate. The faster a juvenile animal grows to maturity in the wild, the faster he or she would presumably be able to win out over competing suitors to mate and produce more offspring. This would tend to select for maximum growth rates, but resource allocation is not the only reason Mother Nature puts on the brakes. Even in a germ-free environment, cells cannot divide and grow while simultaneously performing at peak efficiency. Faster-growing fish, for example, swim less efficiently than slower-growing fish.1898 [2196] Faster-growing rainbow trout have been shown to have significantly impaired swimming performance.1899 [2197] The critical swimming speed of salmon genetically engineered to grow more than twice as fast by length as control fish is only half the speed of control fish.1900 [2198] Not only do broiler chickens bred for accelerated growth have smaller immune organs, but what little immunity they do have may not be functioning effectively. The budgetary analogy, therefore, is imperfect. ItR17;s not that thereR17;s just a certain amount of resources to go around and every dollar spent on infrastructure is a dollar not spent on defense. ItR17;s worse than that. By forcing broiler chickens to divert the lionR17;s share of resources to fast growth, not only is host security left to hold bake sales, but immune defenses may be actively undermined. The industry has tried to shore up the imposed deficiencies with feed restriction programs, improved sanitation, and chemoprophylactic treatments.1901 [2199] USDA researchers note in a 2005 Poultry Science article: R20;Much of the progress seen in intensive poultry production over the past 50 yr has been possible due to the availability of very effective and inexpensive antibiotics which have prevented stress-induced opportunistic bacterial disease and allowed efficient production even as density and growth rate increased.R21; The researchers go on to show displeasure that human health concerns are pressuring the industry away from such crutches.1902 [2200] Despite drugs and new vaccines, the head of the prestigious Wageningen University Animal Production Systems group reached the sobering conclusion long ago that a modern broiler chicken R20;still cannot cope adequately with its pathogenic environment.R21;1903 [2201] There is only so far we may be able to subordinate chicken biology to the dictates of industrial production before running into unintended consequences.1904 [2202] R20;We are severely changing the way these animals grow,R21; remarked one poultry geneticist in R20;High Yielding Broiler Production: The Big Trade-Off,R21; an article in Broiler Industry. R20;I believe the time is rapidly approaching when management alone wonR17;t be able to overcome the genetic problems because of the metabolic stresses that are being put on these birds.R21;1905 [2203] Or, as Rachel Carson put it 40 years ago, R20;Nature fights back.R21;1906 [2204] The history of industrial agriculture in general is replete with technological fixes associated with unforeseen consequences, such as DDT. An academic history of the broiler industry views intensive poultry production as paradigmatic in this regard. The author writes: R30;virtually every effort to further industrialize broiler biology has resulted in the emergence of new risks and vulnerabilities. Intensive confinement combined with increased genetic uniformity has created new opportunities for the spread of pathogens. Increased breast-meat yield has come at the expense of increased immunodeficiency. And, of course, widespread recourse to antibiotics has created a niche for the proliferation of resistant bacteria.1907 [2205] In an industry whose bottom line is the bottom line, though, it all makes good business sense. The poultry industry accepts the fact that broilers with the fastest growth rates start suffering from heart failure as they reach slaughter-weight and may just keel over dead, even after they have R20;already consumed almost all of their feed allowance and therefore taking the largest possible slice out of the profit.R21;1908 [2206] But not only is that readily factored into the equation, it may be welcomed as a sign of good breeding. As one chicken farmer wrote, R20;Aside from the stupendous rate of growthR30;the sign of a good meat flock is the number of birds dying from heart attacks.R21;1909 [2207] An interesting proviso is added by leading poultry breeding expert Gerard Albers. Although R20;decisions in the poultry industry are largely and increasingly driven by economic considerations,R21; Albers notes, R20;the psychological impact of flock morbidity and mortality on the farmer cannot be ignored. Mortality rates above a certain psychological threshold are unacceptable.R21; The excess mortality may just become too disturbing. Albers is not optimistic, though, that breeding for R20;increased livabilityR21; will take precedence over selection for R20;more profitableR21; traits.1910 [2208] The same attitude pervades the egg industry. In an article titled, R20;Industrial Perspective on Problems and Issues Associated with Poultry Breeding,R21; laying hen breeding corporations insist that R20;[e]gg production per hen housed will continue to be the single most important trait under selection.R21;1911 [2209] In the broiler chicken industry, the costs of production diseases are estimated at 10% to 20% of total production costs,1912 [2210] a small price to pay for jumbo-sized birds. It is simply not in the financial interest of the industry to fully mitigate disease rates. As poultry researchers have asked, R20;Is it more profitable to grow the biggest bird and have increased mortality due to heart attacks, ascites [heart failure], and leg problems, or should birds be grown slower so that birds are smaller, but have fewer heart, lung, and skeletal problems?R21; Their answer: R20;A large portion of growersR17; pay is based on the pound of saleable meat produced, so simple calculations suggest that it is better to get the weight and ignore the mortality.R21;1913 [2211] In the face of bird flu viruses like H5N1, though, the deaths of chickens arenR17;t the only mortalities the industry may be ignoring. The industry could breed for improved immunity even though it has R20;been shown to result in decreased body weight,R21;1914 [2212] but openly admits that R20;disease resistance will not be selected for if the cost in a loss of genetic improvements in other traits is too great.R21; The industry prefers to externalize, or pass along, disease costs to the human population. R20;For example,R21; an industry breeding text reads, R20;to select for effective resistance to Salmonella would currently cost so much in performance that it would be totally unfeasible.R21;1915 [2213] It doesnR17;t seem to matter that Salmonella rates in poultry continue to rise in the United States,1916 [2214] nor that hundreds of Americans die from Salmonella every year.1917 [2215] Let the consumers sterilize their meat thermometers and be extra careful not to drip a drop of fecal fluid on their kitchen floor so as not to endanger their toddlers. Europe is reconsidering its breeding program. The European CommissionR17;s Scientific Committee broiler chcken report stated that its R20;most important recommendationR21; was that R20;[b]reeders should give a considerably higher priority to health variables in the breeding index, if necessary at the expense of the selection pressure for growth and feed conversion.R21;1918 [2216] Meanwhile in the United States, growth rates continue to be pushed faster every year.1919 [2217] One poultry specialist mused, R20;Mathematically, it is evident that the present rate of improvement in growth cannot be continued for more than a couple of decades, or the industry will be faced with a bird that virtually explodes upon hatching.& (c) BirdFluBook.com | Home [2218] | Website by Lantern Media [2219] Bird Flu - Monoculture BirdFluBook.com [2220] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2221] Monoculture A handful of corporations supply most of the breeding stock for all the worldR17;s poultry. Indeed, as of 2000, more than 95% was provided by just four turkey breeding companies, five egg-laying chicken breeders, and five broiler breeder companies.1923 [2222] Soon, the industry predicts, there essentially may only be three poultry breeders in the entire world.1924 [2223] A single pedigree cockerel can potentially give rise to two million broiler chickens.1925 [2224] Mass consolidation has positive and negative aspects. On the plus side, selection decisions can be propagated around the entire world in a matter of years. If the industry decided to prioritize selection for stronger immunity, in three or four years, practically the entire global flock could be replaced with the healthier, disease-resistant variety. The flip side is that further emphasis on production traits with detrimental effects on immunity are distributed at the same speed.1926 [2225] Another downside is the increasing genetic uniformity of poultry worldwide, which alone may increase the susceptibility of the global flock to disease.1927 [2226] According to the FAO, over the last century, 1,000 farm animal breedsR12;about one-sixth of the worldR17;s cattle and poultry varietiesR12;have disappeared.1928 [2227] Breeds continue to go extinct at a rate of one or two every week. More than 1,000 breedsR12;one out of four of all livestock varietiesR12;are presently facing extinction.1929 [2228] The greatest threat to farm animal diversity, according to the FAO, is the export of high-producing breeding stock from industrialized to developing countries that dilutes, or completely displaces, local native breeds.1930 [2229] This erosion of biodiversity has human public health consequences. The American Association of Swine Veterinarians has explained why the genetic bottlenecking created by narrowly focused breeding schemes may be a main reason for the mounting concern over human zoonotic diseases. R20;As genetic improvement falls into the hands of fewer companies and the trend towards intense multiplication of a limited range of genotypes (monoculture, cloning) develops, there is mounting concern that large populations may have increasingly uniform vulnerability to particular pathogens.R21;1931 [2230] This is the risk posed by any type of agricultural mono-cropping. We can learn from past mistakes. In the early 1970s, for example, the U.S. corn industry developed R20;TcmsR21; corn, a highly profitable strain adapted for large-scale farming. Only after 85% of the nationR17;s seed corn acreage was covered with the new variety did the industry realize that the strain also happened to be particularly susceptible to a rare form of leaf blight fungus that then wiped out areas of the U.S. corn belt.1932 [2231] Turkey producers have the option of rearing heritage breeds and so R20;may be able to improve both disease resistance and the safety of their poultry products,R21; University of Arkansas poultry scientists point out, R20;by choosing slower growing commercial linesR30;.R21;1933 [2232] There may not be sufficiently slow-growing commercial lines of broiler chickens from which to choose at present, but they could be created if sufficient political will were directed at such a task. The U.S. poultry industry has started injecting genetic diversity from native Chinese lines of heirloom chickens in hopes of strengthening the immunity of the U.S. flock. R20;Some of the Chinese chickens have been shown to be very disease resistant,R21; explains one Hong Kong University zoologist. R20;Because they have not been under heavy selective breeding, in general their disease resistance is very high.R21;1934 [2233] Given the inverse relationship between immunity and accelerated growth, though, the industry may not go far enough. In response to the stalemate between disease resistance and short-term profitability, the industry is experimenting with creating a transgenic R20;superchicken,R21; genetically engineered to be resistant to avian influenza.1935 [2234] This is reminiscent of the cattle industryR17;s attempt to invent mad cow disease-resistant cattle. Might it not be more prudent to simply stop feeding natural herbivores slaughterhouse waste? Prudent, perhaps, but hardly economical. Five years ago, New Scientist editorialized: [W]hy are animal diseases such a problem in countries like Britain anyway? The answer lies less in the DNA of our cows and pigs and more in our subsidized system of intensive farming and long-distance trading in animals which encourages infections. There is a danger that genetic modification will be used to shore up this system by making farm animals better equipped to survive cramped conditions. Indirectly, it could even help to spread disease susceptibility by encouraging farmers to switch from genetically diverse breeds to high-yield GM [genetically modified] animals drawn from a narrow gene pool.R21;1936 [2235] Biodiversity is biosecurity. Even the most virulent of diseases typically do not kill all infected individuals, in part due to natural inborn genetic variability. In the wild, natural selection takes advantage of this variation to pass disease-resistant qualities to the next generation.1937 [2236] The diversity in nature tends to ensure that some individuals will survive whatever comes along. Artificial selection for production qualities undermines Mother Nature in two ways, by inbreeding unnaturally elevated egg production and fleshiness over fitness, as well as by reducing the genetic diversity that can act as resistance insurance against present and unforeseen threats of disease.1938 [2237] (c) BirdFluBook.com | Home [2238] | Website by Lantern Media [2239] Bird Flu - Acquired Immunodeficiency Syndromes BirdFluBook.com [2240] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2241] Acquired Immunodeficiency Syndromes Tumors on chicken's leg from Marek's disease The overcrowded, stressful, unsanitary conditions inherent to intensive poultry production not only directly increase the risk and spread of bird flu infection, but may predispose the birds to infections with immunosuppressive viruses that could further compromise their already dysfunctional immune systems. The relationship between immune-weakening poultry viruses and bird flu was first proposed by University of Hong Kong zoologist Frederick Leung and later expanded upon by anthropologist and agroecologist Ronald Nigh.1939 [2242] Leung noted a speculative correlation between Hong Kong chicken farms that had suffered outbreaks of an immunodeficiency virus known as infectious bursal disease virus in 1996 and the subsequent initial outburst of H5N1 about six months later in 1997.1940 [2243] The bursa is a specialized avian organ responsible primarily for the development of a birdR17;s immune system.1941 [2244] ThatR17;s how human antibody-producing R20;B-cellsR21; got their name, since they were first discovered in chickens.1942 [2245] Just as HIV in humans replicates in white blood cells called T-helper cells, leading to their destruction and the bodyR17;s subsequent immunodeficiency, the infectious bursal disease (IBD) virus in birds infects B-cells, crippling the immune system and leaving survivors immunosuppressed for life.1943 [2246] With a R20;severely impairedR21;1944 [2247] ability to produce antibodies, surviving birds respond poorly to vaccinations1945 [2248] and are susceptible to a wide variety of viral, bacterial, and parasitic diseases.1946 [2249] Beginning in the 1980sR12;a couple of decades after the IBD virus was identified1947 [2250] R12;the United States started seeing a dramatic increase in chickens suffering from various respiratory infections. Vaccines no longer seemed to be working as effectively.1948 [2251] Investigators discovered that a new hypervirulent strain had arisen in the most concentrated poultry production area in the world,1949 [2252] the Delmarva peninsula, incorporating corners of Delaware, Maryland, and Virginia.1950 [2253] The Delaware variant, as it was called, started its march across the world in the late R17;80s1951 [2254] thanks in part to a R20;high concentration of poultry in close proximity.R21;1952 [2255] ThereR17;s even evidence that the IBD virus of domestic chickens has been detected in Emperor penguins in the Antarctic, considered an example of industrial animal agricultureR17;s R20;pathogen pollutionR21; to the farthest reaches of the globe.1953 [2256] There has also been a dramatic increase in the virulence of another viral afflictionR12;MarekR17;s disease (MD), first described a century ago1954 [2257] R12;since the 1960s.1955 [2258] Besides tumors in the skin, muscles (meat), nerves, and abdominal organs of chickens, the MarekR17;s disease herpes virus also causes immunosuppression.1956 [2259] A major 2005 scientific review describes the evolution of virulence in what is now a familiar story: Poultry production up to the mid 1900s mainly comprised backyard farming with very low population densities of birdsR30;with low growth rates and low egg production. In this environment, MD was not considered as a major disease even though outbreaks of MD were reported in different parts of the world. However, since the 1960s there have been major changes in poultry production practices. Today poultry production has become a major global industry operating in very high population densities under highly intensive management conditions aimed at higher rates of growth and productivityR30;. Until about 1960, when the poultry production was not on an intensive scale, both the virus and the hosts were able to achieve a state of balanced co-existence. However, the transformation of the poultry industry into the intensive production practices from the early 1960s saw a shift in this balance greatly in favor of the virus. The continuous availability of large populations of genetically susceptible naďve hosts, usually in an overcrowded environment, enabled the virus to spread rapidly, encouraging their rapid evolution towards greater virulence. This was evident when huge MD outbreaks swept through poultry flocks in the 1960s, wiping out large populations all around the world1957 [2260] The first wave of evolution in the late 1950s shifted the virus from R20;mMDVR21; (mild MarekR17;s disease virus) to R20;vMDVR21; (virulent MarekR17;s disease virus). Due in part to continued and escalating industrial practices, R20;vMDVR21; became R20;vvMDV,R21; and presently the world is dealing with R20;vv+MDV.R21;1958 [2261] The industry had created another monster. Other immunosuppressant viruses include chicken infectious anemia virus (CIAV) and a virus that causes hemorrhagic enteritis in turkeys.1959 [2262] CIAV was first described in 19791960 [2263] and has since spread throughout the world to become ubiquitous in egg and meat-type chickens worldwide.1961 [2264] CIAV destroys immune precursor cells, undermining the immune system before it can even develop.1962 [2265] Immunosuppression associated with CIAV is considered to be a factor in R20;many of the disease problems in flocks raised under the high-density conditions of modern poultry production.R21;1963 [2266] These immunodeficiency viruses can interact with each other to synergistically further predispose the global chicken flock to infection. CIAV infection, for example, can boost the virulence of MarekR17;s virus,1964 [2267] and co-infection between IBDV and CIAV can result in an even more profound vulnerability to additional infectious disease agents.1965 [2268] A TysonR17;s poultry scientist describes the U.S. poultry industry as being R20;in a constant battle with immunosuppressive diseases,R21;1966 [2269] and a 2005 World Poultry R20;Global Disease UpdateR21; reports that R20;[t]he deleterious effects of infections which suppress the immune systems are underrated in many parts of the world.R21;1967 [2270] The unhygienic conditions under which commercial poultry are confined conspire to spread these viruses. R20;The transformation in the poultry farming practices into a highly intensive industry has enormously changed the poultry house environment,R21; reads one MarekR17;s disease review. Infection with MarekR17;s disease occurs when a chicken inhales infected dust in a poultry shed saturated with virus flaking directly off the chickensR17; skin.1968 [2271] The emergence of new strains of IBDV has also been blamed in part on R20;improper cleaning and disinfection.R21;1969 [2272] One reason why the industry doesnR17;t clean and disinfect sheds more frequently is that they want young breeding chickens to get infected with viruses like CIAV early in hopes that they will clear the infection before egg laying leads to progeny with R20;poorer performance.R21;1970 [2273] Immunodeficiency diseases like MarekR17;s cost the poultry industry more than a billion dollars a year,1971 [2274] but cleaning up its act might cost even more. One animal science textbook explains that R20;compromise inevitably must be struck because animal agriculture is a business, and providing the best environment possible may be unprofitable.R21;1972 [2275] None of these viruses affect humans directly, but with the threat of bird flu, anything that leads to immune suppression in chickens may now be an issue of human public health importance. The same factory farming conditions that facilitated the emergence of killer viruses like H5N1 are leading to the emergenceR12;and spreadR12;of immunodeficiency viruses that may themselves be partially responsible for H5N1 and may midwife even deadlier pandemic strains into the world. (c) BirdFluBook.com | Home [2276] | Website by Lantern Media [2277] Bird Flu - Chicken Run BirdFluBook.com [2278] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2279] Chicken Run Clearly, stressful, overcrowded confinement in industrial poultry facilities facilitates immune suppression in birds already bred with weakened immunity, offering viruses like bird flu ample opportunities for spread, amplification, and mutation. Placing inbred birds into these kinds of unsanitary environments without the chance for a breath of fresh air or a ray of sanitizing sunshine seems the perfect storm environment for the evolution of the next superflu strain of pandemic influenza. Why then has there been concern about the opposite: free-range flocks? Sociography scholar Mike Davis blames the international corporate poultry sector for launching a global offensive to blame small producers,1973 [2280] the hundreds of millions of farmers raising a dozen or so birds in their backyards.1974 [2281] The commercial poultry industry boasts of R20;biosecurity,R21; described as the industryR17;s R20;buzzword du jour,R21;1975 [2282] arguing that keeping birds confined indoors year-round protects them from exposure to wild birds and any diseases they might be carrying.1976 [2283] The U.S. National Pork Board defends large-scale pig confinement using the same rationale.1977 [2284] After the Hong Kong outbreak, Webster wrote that hypothetically, past outbreaks of high-grade viruses R20;could probably have been prevented if domestic poultry had been raised in ecologically controlled houses that maintained a high standard of security and limited access.R21;1978 [2285] This makes sense, but only in theory. In practice, whether trying to stem the spread of H5N1 or prevent outbreaks of highly pathogenic bird flu in the first place, locking birds in industrial confinement operations may increase the public health risk on a global scale. The Thai poultry industry has used bird flu as an excuse to further industrialize its production systems. Thai poultry baron billionaire Dhanin Chearavanont, a leader in the R20;TysonizationR21; of Southeast Asia, convinced the government that his factory farms were the safest way to raise chickens,1979 [2286] effectively forcing thousands of small farmers out of business. The government started yoking peasants under contract to corporate R20;chicken farming estatesR21;1980 [2287] and mandated that only owners of closed farms would receive compensation for restocking flocks culled for disease control.1981 [2288] But H5N1 is wiping out birds on R20;closedR21; farms, too. One of ChearavanontR17;s own farms containing more than 100,000 birds became infected,1982 [2289] and in general, an underreported 2006 Food and Agriculture Organization of the United Nations research report out of Johns Hopkins University found that industrial-scale chicken and egg operations in Thailand were proportionally four-times more likely to suffer outbreaks than backyard flocks.3197 [2290] Likewise, despite millions of free-range chickens in France1983 [2291] and Nigeria,1984 [2292] the first outbreaks in Europe and Africa, respectively, involved a farm confining more than 11,000 turkeys1985 [2293] and a battery-cage egg facility in which 40,000 chickens died.1986 [2294] The first outbreak in Britain was at a 160,000 turkey factory owned by the largest turkey producer in Europe3198 [2295] with an annual turnover of nearly a billion dollars.3199 [2296] Thai neighbors Cambodia and Laos present case studies for comparison. While Thailand so heavily industrialized production that it became the fourth-largest poultry exporter in the world,1987 [2297] the majority of poultry production in Cambodia and Laos has remained extensive (rather than intensive) and comprised largely of farmers with small outdoor flocks. In which countries did bird flu spread to the greatest extent? In countries where most birds were intensively confined indoors or in those where most of the chickens were raised outdoors? According to the Food and Agriculture Organization, R20;Evidence suggests that HPAI [highly pathogenic avian influenza] did not become established in Cambodia to the extent that it did in Vietnam and Thailand,R21; referring to the two countries on either side of Cambodia. R20;This may be attributable in large part to the primarily extensive nature of the poultry industry (poultry density in Cambodia is much lower (less than 30%) than in Thailand and Vietnam)R30;.R21;1988 [2298] The USDA reported a similar phenomenon in Laos, the other country sandwiched between Thailand and Vietnam. Of the few outbreaks that did occur in the country, more than 90% broke out in commercial poultry operations, not free-ranging flocks.1989 [2299] Compared to 115 cases of human H5N1 infection in Thailand and Vietnam, there have been 6 cases recorded in Cambodia and not a single one in Laos.1990 [2300] Past outbreaks of bird flu offer further hindsight. In 2004, while H5N1 was blasting across southeast Asia, a highly pathogenic H7N3 outbreak swept through CanadaR17;s Fraser Valley east of Vancouver.1991 [2301] Dozens of poultry workers involved in the gassing and incineration of the 19 million chickens culled developed symptoms of infection.1992 [2302] Laboratory-confirmed bird flu infections in two workers1993 [2303] prompted the World Health Organization to raise CanadaR17;s R20;pandemic preparedness levelR21; to the same as those Asian countries affected by H5N1.1994 [2304] Canadian agriculture interests in government seemed no better than their Asian counterparts in terms of transparency: The Canadian Food Inspection Agency not only initially denied the existence of human infections to the public but withheld the information from the provincial Centre for Disease Control, an omission the Centre said R20;could have had severe consequences.R21;1995 [2305] Thankfully, both workers were successfully treated with Tamiflu and all other presumed human cases were resolved without reported complication.1996 [2306] The backyard chicken farmers blamed the commercial industry for the outbreak,1997 [2307] and the industry blamed the small farmers.1998 [2308] An industry spokesperson not only denied that high-density broiler chicken sheds played a role in the outbreak, but challenged the assertion that the sheds were overcrowded at all. R20;Anything that creates a better environment for our birds,R21; the spokesperson said, R20;basically makes our industry stronger.R21;1999 [2309] R20;Only healthy animals produceR21; is a common defense used by proponents of factory farming. Profitability does depend on productivity, but productivity is not measured on a per-animal basis. R20;Productivity,R21; according to University of California-Davis poultry specialist Joy Mench, R20;is often measured at the level of the unit (e.g., number of eggs or egg mass per hen-housed), and individual animals may be in a comparatively poor state of welfare even though productivity within the unit may be high.R21;2000 [2310] Some of the worst problems are created by some of the most profitable practices, such as breeding for accelerated growth rates,2001 [2311] which leaves many birds crippled, brittle-boned, bloated from heart failure, and scarred with ammonia burns after squatting in their own waste. Industry insiders admit that the R20;success of the modern poultry industry has also created an environment very favourable to highly contagious agents.R21;2002 [2312] Publicly, the industry denies culpability. Internally, it admits to R20;the growing realization that viruses previously innocuous to natural host species have in all probability become more virulent by passage through large commercial populations.R21;2003 [2313] An August 2005 article in the trade journal Poultry International offers a concise explanation of the role of large-scale production: The AI virus lives harmlessly in the ducks popular in Asia to control insect pests and snails in rice paddies. If this duck R16;flu passes to chickens kept nearby, it can mutate into a deadly and highly contagious strain that speeds rapidly with accompanying high mortality. The larger the flocks and the more intensive the production level, the more scope there is for the disease to spread for genetic changes to the virus.2004 [2314] This is the same conclusion reached by many in the Canadian scientific community. University of OttawaR17;s Earl Brown explained to the Canadian Press: R20;If you get a [H5 or H7] virus into a high-density poultry operation and give it a period of time, generally a year or so, then you turn that virus into a highly virulent virus. ThatR17;s what always happensR30;.R21;2005 [2315] CanadaR17;s National Manager of Disease Control within the Food Inspection Agency seems to agree: R20;Just passing the virus to 3,000 or 4,000 chickens is enough to change a harmless virus into something more pathogenic.R21;5006 [2316] R20;It is high-density chicken farming that gives rise to highly-virulent influenza viruses,R21; Brown concluded. R20;ThatR17;s pretty clear.R21;2007 [2317] These conclusions were based on the best available science. The Canadian outbreak first erupted not in a backyard flock or free-range farm, but on an entirely enclosed, R20;sophisticatedR21; industrial facility. It then jumped from broiler shed to broiler shed, largely skipping free-range farms.2008 [2318] The spread of the virus was traced mainly to the human lateral transmission of infective feces via equipment or some other carrier moved from farm to farm.2009 [2319] This may also explain how the virus was first introduced into the industrial broiler houses. Chickens donR17;t need to come in direct contact with ducks to get infected; they just need contact with the virus, which can be walked into a R20;biosecureR21; operation on someoneR17;s clothing.2010 [2320] In the end, epidemiological analyses placed commercial flocks in the 2004 Canadian outbreak at 5.6 times more likely to be infected than backyard flocks. Infected backyard flocks were discovered after nearby commercial flocks were infected, suggesting that the virus spread from the industrialized operations to free-range poultry, and not vice versa.2011 [2321] Birds kept outdoors are more likely to come in contact with wild waterfowl, but also with sunlight, space, and fresh air. Lower stress levels may help their bodies better resist the initial infection, and, since they donR17;t live on layers of their own waste cramped into poorly ventilated sheds by the tens of thousands, the virus may not spread effectively enough to mutate into a killer. Instead of blaming backyard flocks, attention should be turned, as a former Vancouver Sun editor put it, to the factory farms, the R20;profitable vulnerabilities built into our food supply.R21;2012 [2322] The largest outbreak of avian influenza before H5N1 exploded in 2004 was the 2003 outbreak of highly pathogenic H7N7 in the Netherlands that infected more than 1,000 people2013 [2323] and killed an investigating veterinarian.2014 [2324] In an article titled, R20;Why Factory Farms and Mass Trade Make for a World Where Disease Travels Far and Fast,R21; the Consumer Affairs correspondent for the Guardian wrote that the disease R20;spread like wildfire through the countryR17;s intensive poultry industry,R21; expanding into Belgium and Germany before being contained2015 [2325] with the slaughter of 30 million birds.2016 [2326] While some blame the rise in factory farming for this outbreak, others blame the rise in free-range farming.2017 [2327] Free-range flocks were not, however, found to be at increased risk during the outbreak.2018 [2328] According to a review in World Poultry, A notable feature of the Dutch epidemic was that large, densely-stocked flocks were worst affected. Some extensively managed [as opposed to intensively managed] flocks were infected by the virus without showing significant illness of either birds or people. This does not mean that everyone should return to high-cost, low-output, production systemsR30;but it does mean that some producers might usefully soften housing and management systems which put excessive strain on birds in terms of stocking density, air quality, group size, population instability and general vitality. After the article goes on to admit to concern that intensive confinement systems may be critically weakening the birdsR17; immune systems and putting the entire poultry industry at risk, it ends by declaring that R20;a chain is only as strong as its weakest link!R21;2019 [2329] Although the Dutch virus did kill one person, most of the symptoms it caused were mild, and hundreds of those infected showed no symptoms at all. However, some who did develop symptoms were able to pass the virus to others in their households. Adapting to chickens seems to have adapted the virus to humans. The Netherlands outbreak showed not only that intensive chicken farms may brew a virus capable of human-to-human transmission, but that such a strain can arise in an advanced industrialized country with modern, high-tech poultry facilities.2020 [2330] With intensive confinement operations spreading around the globe, southern China may lose its distinction as the purported pandemic epicenter of the world.2021 [2331] In Chile in 20022022 [2332] and in Italy and Mexico in the 1990s, the same scenario played out. A low-grade waterfowl virus found itself locked inside a building with thousands of chickens, leading to the R20;now predictable mutation to a highly pathogenic virus.R21;2023 [2333] In Mexico, a low-grade H5N2 virus causing no more than mild respiratory symptoms in chickens found its way into industrial poultry facilities outside Mexico City and turned deadly,2024 [2334] eventually affecting nearly a billion birds throughout the country.2025 [2335] The R20;informative, but frighteningR21;2026 [2336] lesson to be learned from the Mexico outbreak is that once a harmless waterfowl virus is introduced into millions of domestic poultry,2027 [2337] it can R20;accumulate multiple mutations and become a highly pathogenic strain that causes high mortality.R21;2028 [2338] The Italian outbreak in 1999R11;2000 among R20;intensively reared poultryR21; caused the deaths of more than 13 million birds in three months and evolved into a virus with 100% morbidity and 100% mortality2029 [2339] R12;meaning that once the virus gets into a flock, every bird gets sick and every bird dies. Over the preceding 20 years, the Italian poultry industry had grown and industrialized dramatically, particularly in the Veneto and Lombardia regions, precisely where the 1999 epidemic broke out.2030 [2340] The epidemic wiped out both broiler chicken and egg-laying operations. World Organization for Animal Health veterinary officials in Italy at the time wrote, R20;To date, HPAI [highly pathogenic avian influenza] has affected virtually all intensively reared avian species regardless of age or housing system.R21;2031 [2341] The virus spread faster in broiler chicken sheds than within battery-cage egg facilities. Caged hens would all eventually succumb to the virus, but it had to spread from cage to neighboring cage, whereas it was able to blast its way throughout the broiler shed in one fell swoop, infecting chickens living directly on their own waste. The investigating scientists suspected then that the behavior of viral spread R20;was probably related to the amount of infected feces in direct contact with the birds.R21;2032 [2342] This suggests that outdoor flocks may be the least at risk since droppings may quickly dry in the sun and open air, rapidly killing any virus contained within.2033 [2343] (c) BirdFluBook.com | Home [2344] | Website by Lantern Media [2345] Bird Flu - Wishful Thinking BirdFluBook.com [2346] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2347] Wishful Thinking Hen in manure pit covered in flies Outbreaks within and between modern, fully-enclosed, R20;biosecureR21; confinement facilities around the world have begged the question of how a virus from wild waterfowl gets inside in the first place. As we know, the virus itself may literally fall from the sky in the droppings of migratory waterfowl. Ducks crisscross virtually every continent in the world, potentially dive-bombing the countryside with virus2034 [2348] from a theoretical height of up to 20,000 feet.2035 [2349] A single duck can drop billions of infectious doses of virus in a single day.2036 [2350] The most comprehensive sampling of North American waterfowl found that up to 60% of juvenile ducks heading south from Canada were infected2037 [2351] and able to actively excrete virus for as long as 30 days.2038 [2352] With decreased and downgraded wetlands in North America2039 [2353] and elsewhere,2040 [2354] waterfowl may be forced to congregate in greater numbers, which would be expected to push infection rates even higher.2041 [2355] Once on the ground outside, the virus may quickly dry up and die unless it is transported to an environment more favorable for survival. The prime conduit for mechanical transfer of infective feces has historically involved contaminated poultry workers or equipment.2042 [2356] Although, even without human involvement, R20;You have a lot of everything,R21; remarks one USDA poultry microbiologist. R20;A lot of birds, a lot of manure, a lot of moisture, a lot of dust. Everything that walked into that houseR12;every two- and four- and six-legged creatureR12;is a potential vector for moving it around.R21;2043 [2357] Rodents, insects, and wildlife could all be vectors ferrying the virus into confinement facilities.2044 [2358] Experimental evidence shows that rats and mice, both huge problems in the poultry industry,2045 [2359] may carry H5N1.2046 [2360] An outbreak in Australia established that starlings and sparrows are also potential spreaders of bird flu viruses,2047 [2361] and other wildlife species found both in waterfowl habitat and on poultry farms, such as skunks, ground squirrels, and raccoons, have been shown capable of harboring bird flu viruses.2048 [2362] According to one poultry veterinarian, R20;Maintaining confinement buildings in a wildlife-proof condition is difficultR30;,R21; especially with factors like ground-frost heaving compromising the integrity of the perimeter during the winter.2049 [2363] DNA fingerprinting studies of Campylobacter suggest contact between housed poultry and wild birds2050 [2364] who may be drawn to the bounty of free food available inside broiler sheds. In trying to describe why wild migratory birds are attracted to poultry operations, Ellen Silbergeld, an esteemed professor at the Johns Hopkins University Bloomberg School of Public Health, explained, R20;You rob a bank because thatR17;s where the money isR12;this is where all the food is, so of course theyR17;re going to try to get insideR30;.R21;2051 [2365] Flies may even carry the contagion. Just as up to 50% of the copious2052 [2366] flies captured near poultry houses have been found carrying the poultry fecal bacteria Campylobacter,2053 [2367] the deadly H5N2 virus was isolated from garbage flies2054 [2368] during the 1980s outbreak in Pennsylvania.2055 [2369] Influenza viruses may even seep into the water supply, with surface water from contaminated ponds potentially leaching into nearby groundwater supplies for confined poultry.2056 [2370] Understandably, a North Carolina State University poultry health management professor wrote in an industry trade journal that R20;high biosecurity and proper monitoring are still wishful thinking in many areas of intensive poultry production.R21;2057 [2371] Increasing intensification is making it even more wishful. The World Organization for Animal Health (OIE) points out that the changes in the global poultry industry over the past 20 years make infectious diseases R20;significantly more difficult to control because of the greater number of susceptible animals reared per given unit of time and to the difficulties in applying adequate biosecurity programmes.R21;2058 [2372] The OIE notes that biosecurity measures may be simply incompatible with modern high-density rearing systems.0259 [2373] R20;When an outbreak of avian influenza occurs in an area with a high [poultry] population density,R21; OIE officials wrote, R20;the application of rigorous biosecurity measures might not be possible.R21;2060 [2374] The industry and USDA researchers2061 [2375] confess that this is one of the disadvantages of the U.S. system: Not only are 20,000 to 25,000 broiler chickens typically confined in a single shed, but there may be up to 16 sheds at a single facility.2062 [2376] There are now egg-laying operations with the capacity to cage more than four million hens in a single complex.2063 [2377] When sheds and farms are situated close enough to one another, the virus may be able to spread through the wind.2064 [2378] Even assuming that all poultry workers, staff, and visitors paid perfect attention to biosecurity protocolsR12;such as scrubbing footwear in disinfectant every time they stepped into a shed and washing their hands three separate times before entering (as instructed by the USDAR17;s instructional video Biosecurity: For the Birds2065 [2379] )R12;a stray barn swallow or housefly could theoretically carry contagion in or out of an intensive confinement facility. And studies show that attention to biosecurity protocol is a far cry from perfect. The U.S. poultry industry claims to have the R20;best biosecurity system in the world,R21;2066 [2380] but academic and governmental investigations have uncovered widespread disregard for biosecurity precautions among large and small domestic producers.2067 [2381] In 2002, University of Maryland researchers sent questionnaires about biosecurity practices to commercial broiler facilities throughout the Delmarva Peninsula, where more than 100 million broiler chickens of various ages are confined at any given time. Fewer than half the facilities returned the survey, and those that did admitted to severe lapses in biosecurity. The researchers conclude that U.S. broiler flocks R20;are constantly at risk of infection triggered by poor biosecurity practices.R21;2068 [2382] In a moment of candor from the industry, Charles Beard, acting as U.S. Poultry and Egg Association vice president, admitted that relying on biosecurity measures to protect the U.S. poultry industry R20;could appear naďve.R21;2069 [2383] R20;After all,R21; he writes, R20;biosecurity is mostly a R16;peopleR17; thing.R21; Even putting human fallibility aside, Beard is concerned that unless all poultry workers R20;join in with conviction and enthusiasm, it is not likely to be successfulR21; regardless of what R20;those in chargeR21; say.2070 [2384] The University of Maryland surveys show biosecurity R20;enthusiasmR21; to be lacking, and the R20;convictionsR21; of poultry corporations like Tyson have leaned more toward 20 felony violations for illegal dumping of untreated wastewater into the nationR17;s rivers2071 [2385] than toward a desire to practice biosecurity. In fact, Tyson Foods, the largest chicken-producing corporation in the world,2072 [2386] found itself before the Supreme Court in 2005 for refusing to pay workers for time spent donning protective clothing at a poultry plant. The Supreme Court ruled unanimously against Tyson.2073 [2387] Breaches in biosecurity occur in modernized facilities around the world.2074 [2388] The European Food Safety Authority recognizes that when this happens in a densely populated poultry area, these breaches can result in R20;massive spread.R21;2075 [2389] The bottom line, according to animal disease control experts, is that biosecurity measures are costly for the industry2076 [2390] and R20;not easy to sustain in the long term.R21;2077 [2391] Emeritus veterinary poultry professor Simon M. Shane, author of the Handbook on Poultry Diseases, even notes a R20;decline in the standards of biosecurity in an attempt to reduce costs in competitive markets.R21; The decline is a contributing factor, Shane concludes, in the frequency and severity of disease outbreaks.2078 [2392] In Poultry Digest, longtime industry insider and avian health expert Ken Rudd wrote a candid article titled, R20;Poultry Reality Check Needed,R21; in which he laid out in stark terms the industryR17;s skewed priorities: An examination of virtually all the changes made in the past decade shows that theyR17;ve come in the guise of convenience and efficiency, but they are, in fact, cost-cutting measures. Few, if any, decisions have been made solely for the sake of avian health or the long-term protection of the industry. The balance between the two has been lost; the scale is now weighted almost entirely on the cost-cutting side. And, therefore, on the side of microorganismsR12;much longer on this earth than humans!2079 [2393] Specifically, Rudd criticizes the profitable yet risky practice of reducing the duration of downtime between flocks and the trend of not cleaning poultry houses between flocks. He pleads with his industry to R20;consider the cost of catastrophe.R21;2080 [2394] One need look no further than other widespread viral disease outbreaks, like foot and mouth disease in Europe, to understand the vulnerability of modern animal agriculture.2081 [2395] In the United States, within three years of the emergence of the highly virulent R20;Delaware variantR21; of the immunodeficiency IBD virus, virtually the entire broiler industry east of the Mississippi was affected.2082 [2396] How can the U.S. poultry industry continue to insist that their facilities are biosecure? If this is the R20;best biosecurity system in the world,R21; then the global industry may need to fundamentally rethink how it raises birds for meat and eggs. The United States, the country that pioneered industrialized poultry production, has reported more bird flu than any other country in the world.2083 [2397] (c) BirdFluBook.com | Home [2398] | Website by Lantern Media [2399] Bird Flu - Made in the USA BirdFluBook.com [2400] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2401] Made in the USA New York City live bird market Bird flu viruses have been detected every year in the United States since the mid-1960s.2084 [2402] In just the last five years, more than a dozen outbreaks of viruses with the potential to mutate into highly pathogenic forms have been discovered.2085 [2403] But the largest to date still remains the 1983 Pennsylvania outbreak that spread down through Maryland and Virginia2086 [2404] and led to the deaths of 17 million domestic birds2087 [2405] at a cost to the nation of more than $400 million.2088 [2406] Investigators speculate that the H5N2 virus responsible for this outbreak may have started out in a flock of wild ducks that landed in a pond on a chicken farm in eastern Pennsylvania.2089 [2407] Duck feces on the boots of a farmer may have first brought the virus inside the broiler sheds.2090 [2408] The virus, like essentially all wild waterfowl viruses, started out benign, causing a drop in egg production or mild upper respiratory symptoms, but soon started R20;racing though giant commercial chicken warehouses.R21;2091 [2409] The now resident director of the University of PennsylvaniaR17;s poultry laboratory explained that R20;with that many opportunities to mutate under those intensive conditionsR21; the virus changed from one that gave chickens the sniffles to the R20;bloody Jell-OR21; virus Webster called R20;chicken Ebola,R21; causing birds to hemorrhage throughout their bodies.2092 [2410] WebsterR17;s team performed genetic analyses of the H5N2 virus before and after it turned lethal. To their surprise, the two differed by only a single amino acid. Amino acids are building blocks strung together in chains that make proteins. The H5 hemagglutinin protein is more than 500 amino acids long.2093 [2411] All it took was a tiny point mutation in the viral genetic material to change the 13th amino acid in the H5 chain from an amino acid named threonine to one called lysineR12;a mutation that, in WebsterR17;s words, R20;change[d] that benign virus into one that was completely lethal.R21;2094 [2412] R20;That such a tiny change in the virus could enable it to wreak so much havoc,R21; Webster and colleagues later wrote, R20;was an awesome discovery.R21;2095 [2413] The U.S. Department of the InteriorR16;s 127-year-old U.S. Geological Survey (USGS) represents the nationR17;s leading governmental authority on the biological sciences.2096 [2414] Reflecting on the evolution of low-grade to high-grade strains of bird flu, the USGS echoes other world authorities in implicating industrial poultry practices not only as providing an R20;excellent opportunityR21; for rapid spread (particularly when R20;poultry are housed at high densities in confined quartersR21;) but in part playing an R20;idealR21; role in possibly sparking the next human pandemic.2097 [2415] H5N2 resurfaced two years later in low-grade form in Massachusetts, New Jersey, Ohio, and again in Pennsylvania,2098 [2416] all traced back to live poultry markets in New York City. A survey of live markets in 1986 found 48 harboring the virus,2099 [2417] suggesting to investigators that live poultry markets may have been the critical mixing point between ducks or geese and chickens that triggered the original Pennsylvania epidemic.2100 [2418] Efforts to purge bird flu viruses from live poultry markets over the years have been unsuccessful,2101 [2419] despite periodic quarantine, depopulation, cleaning, and disinfection. In 2004 an outbreak of highly pathogenic H5N2 was discovered in a 7,000-chicken broiler flock in Texas after the owner introduced a chicken from a live poultry market in Houston into his flock.2102 [2420] Considering the Hong Kong outbreak and other U.S.2103 [2421] and Italian outbreaks traced to live poultry markets,2104 [2422] USDA poultry researchers describe live bird markets as the R20;missing link in the epidemiology of avian influenza.R21;2105 [2423] The first human case of bird flu infection in the United States was in 2002. An H7N2 virus caused more than 200 outbreaks in chicken and turkey operations across a mass poultry production area first in Virginia, and then into West Virginia and North Carolina, leading to the destruction of almost 5 million birds.2106 [2424] It was a low-pathogenicity virus and only suspected in one human infection,2107 [2425] but genetic analyses show that it is mutating toward greater virulence.2108 [2426] In 2003, a person was admitted to a hospital in New York with respiratory symptoms and was confirmed to have been infected with the H7N2 bird flu virus. Despite a serious underlying medical condition, the patient recovered and went home after a few weeks.2109 [2427] By that year the virus had swept through millions of egg-laying hens in huge battery-cage facilities in Connecticut and Rhode Island,2110 [2428] outbreaks that the industry admits R20;confirm the vulnerability of egg production units.R21;2111 [2429] OIE expert Ilaria Capua describes it as R20;very difficultR21; to keep an industrial battery-cage egg facility clean and prevent spread from farm to farm via eggs, egg trays, and equipment. R20;In our opinion,R21; she told the Fifth International Symposium on Avian Influenza in 2003, R20;when the infection gets into a circuit, it will spread within that circuit. It finds its way to spread.R21;2112 [2430] The way H7N2 was found to spread in the United States was via live poultry markets. The markets were suspected in the outbreaks in Pennsylvania (1996,2113 [2431] 1997, 1998, 2001, and 20022114 [2432] ), Virginia (2002),2115 [2433] Connecticut and Rhode Island (2003), and Delaware (2004).2116 [2434] The Delaware outbreak in a broiler operation confining more than 85,000 chickens spread to Maryland before being stamped out by killing more than 400,000 birds.2117 [2435] In two cases, direct epidemiological evidence links the presence of trucks hauling birds to live poultry markets at affected farms within a week before the appearance of clinical disease.2118 [2436] The trucks deliver birds from the farms to the markets, pick up the empty dirty crates, and then return to the farms. The R20;most likely scenario,R21; according to USDA scientists, is that the crates or trucks were not completely disinfected of the potential billions of infectious particles present with any gross fecal contamination.2119 [2437] The University of Georgia Southeastern Cooperative Wildlife Disease Study describes the U.S. live poultry market system as an R20;intricate web of retail markets, poultry auctions, wholesale dealers, and farm flocks.R21; The study notes that in this system, R20;birds may change hands up to five times before reaching the consumer,R21; increasing exposure and decreasing trackability.2120 [2438] Scientists have watched H7N2 since its emergence in live poultry markets in the United States in 1994. As mentioned earlier, the virusR17;s fail-safe mechanism that shackles it from becoming too dangerous in its natural waterfowl host is the hemagglutinin activation step that limits viral replication to R20;safeR21; organs in the body like the intestine. Once placed in a land-based host like a chicken, though, viral mutants that can infect all the victimR17;s organ systems may have a selective advantage since easy waterborne spread is no longer possible. H5 and H7 viruses can transform by accruing basic (as opposed to acidic or neutral) amino acids in the hemagglutinin protein cleavage site, where the enzymes of the host activate the virus. Once the virus accumulates approximately five basic amino acids, it may transform from a low-pathogenicity virus (LPAI) to a highly pathogenic virus (HPAI). The earliest H7N2 isolates in U.S. live poultry markets in 1994 already had two basic amino acids in the critical cleavage site. By 1998, the virus was up to three. Then, in 2002, H7N2 viruses were found with four. Only one more tiny mutation and the virus could have become deadly.2121 [2439] Even though the virus was technically still an LPAI virus, the federal government could see the writing on the wall and stepped in to stamp out H7N2 wherever it escapedR12;and indemnify the industry.2122 [2440] Efforts to eradicate the virus at the sourceR12;in live poultry marketsR12;have failed. According to the USDA Animal and Plant Health Inspection Service, R20;Despite educational efforts, surveillance, and increased state regulatory efforts, the number of [virus] positive markets has persisted and increased.R21; In 1998, 30% of the markets were infected with H7N2, particularly in the New York metropolitan area. New York has more live markets than all other states in the Northeast combined.2123 [2441] By 2001, inspectors could find the virus at 60% of markets at any one time.2124 [2442] The states were failing to control the problem. With the virus dangerously close to potentially locking in that final mutation, the USDA had to intercede, coordinating a system-wide closure of all retail live poultry markets throughout the northeastern United States in 2002. Following the mass closure, all birds were sold off or killed, and all markets were cleaned and disinfected, left empty for days, and then repopulated with birds only from closely monitored source flocks confirmed to be negative for all avian influenza viruses. Then they watched and waited. Within five weeks, H7N2 was back. It is unknown whether the virus somehow persisted in the markets or was reintroduced. Regardless, despite their best efforts at eradication and control, it seems clear that live poultry markets represent a public health risk. Writing in the Journal of Virology, USDA researchers concluded that R20;the rampant reassortment of AIVs [avian influenza viruses] in the LBMs [live bird markets] could increase the risk of species crossover because it would increase the chances of the occurrence of the correct constellation of genes to create a virus that replicates efficiently in mammals.R21;2125 [2443] The mass market closure and disinfection did seem to knock the virus back a step, though, back to three basic amino acids.2126 [2444] Still, unless all live poultry markets are closed, H7N2 will presumably continue its march towards virulence. As the director of the virology lab at Cornell UniversityR17;s Animal Health Diagnostic Center put it, R20;It is two major mutations away from becoming a virus that could kill a lot of chickens and become much more pathogenic to people.R21;2127 [2445] In 2006, USDA researchers published the results of a study which genetically engineered mutants of an H7N2 virus discovered in New Jersey. They found that the insertion of just a single basic amino acid in the right place could transform the virus into a highly pathogenic form.3184 [2446] Currently, many suspect that H5N1 is going to beat H7N2 to the pandemic punch, but were it not for H5N1, the betting might be on live poultry markets in New York CityR12;not Hong KongR12;to deliver the next killer superflu virus. According to the USDAR17;s Agricultural Research Service: The U.S. currently has the largest, most genetically homogeneous and, thus potentially, the most disease-susceptible population of food animals in the history of mankindR30;The emergence of a new disease or a slight shift in the epidemiology of an existing disease could lead to immediate and disastrous results for American livestock producers and consumers.2128 [2447] In light of the emergence of SARS and H5N1 from live animal markets, a 2006 scientific review concluded that R20;the most optimal strategy is to forbid all kinds of live animals at wet-markets, with enforcement of central slaughtering.R21;3183 [2448] If traditional live bird markets can be successfully shut down in Asia, they should be able to be shut down in North America as well. Starting in 2008, those found publicly slaughtering birds in Taiwan, for example, may face a NT$500,000 fine (W76;US$15,000).3181 [2449] Though there has never been a recorded outbreak in Taiwan, the Chairman of their National Science Council explained their reasoning behind the ban: R20;We can't foresee whether an outbreak of bird flu will happen in Taiwan, but every nation in the world is obligated to take part in the prevention of the epidemic.R21; 3182 [2450] The Virginia outbreak in 2002 that led to the deaths of millions of birds and found its way onto hundreds of farms highlights just how wishful the thinking is that industrial poultry populations are protected by biosecurity. Based on the rapid spread of bird flu in United States in 2002, leading USDA poultry researchers have concluded the obvious: R20;[B]iosecurity on many farms is inadequate.R21;2129 [2451] The situation has not necessarily improved since then, according to the executive editor of Poultry magazine and professor of poultry science at Mississippi State. In 2005, she editorialized R20;I believe it is time to reexamine biosecurity in our industry. WeR17;ve become lax in many ways, and this is exactly what it took to get the 1983 AI outbreak moving.R21; She continued, R20;If WHO is right and a pandemic brings human AI to the United States, will you be able to look your family and neighbors in the eye and say youR17;ve done all you can to stop the spread? Having to answer that question alarms me!R21;2130 [2452] (c) BirdFluBook.com | Home [2453] | Website by Lantern Media [2454] Bird Flu - Taming of the Flu BirdFluBook.com [2455] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2456] Taming of the Flu Imperial College pandemic simulation of Thailand The only way to truly stop a pandemic, it has been suggested, is to stamp it out at its source.2131 [2457] Once it starts, according to the editorial board of the journal of the Canadian Medical Association, R20;School closure, quarantine, travel restrictions and so on are unlikely to be more effective than a garden hose in a forest fire.R21; But every forest fire starts with a spark. Some experts believe that, at least theoretically, if caught early enough, a pandemic ember could be extinguished. ItR17;s like a spark and a squirt gun, suggests the director of the U.S. National Vaccine Program. R20;If you aim properly you can get the spark and be done with it. If you miss, though, the fire is going to spread and there is nothing you can do to stop it.R21;2132 [2458] Two independent mathematical modelsR12;one out of the Imperial College of London,2133 [2459] the other from Emory2134 [2460] R12;were published in 2005 suggesting that under the right conditions, a pandemic outbreak might be able to be snuffed at the source in a matter of months. If their approach worked, instead of half the world becoming infected, less than 150 individuals might succumb.2135 [2461] The strategyR12;called R20;ring-fencingR21; or R20;ring tamifluationR21;R12;would be to surround the outbreak at its source and smother it by blanketing everyone in the area with antiviral drugs.2136 [2462] R20;Basically,R21; wrote one of the lead biostatisticians, R20;you contain it at the source or you fail.R21;2137 [2463] There are caveats. The models assume that the outbreak is rapidly detected and reported while still in limited human clusters restricted to a small geographical area. The virus would have to be caught before it gets highly contagious.2138 [2464] As many as 30 million tablets of Tamiflu would have to be immediately shipped in and effectively distributed throughout a potentially sprawling region.2139 [2465] No one could be allowed in or out.2140 [2466] ThatR17;s the computer model. In the real world, odds are the outbreak would not be detected in timeR12;countries in Southeast Asia tend to have poor surveillance capabilities and are reluctant to admit outbreaks even when detected.2141 [2467] R20;If you canR17;t do it with the speed of a smoke alarm and a fire truck, you donR17;t have a chance in hell of stopping this,R21; Osterholm told a reporter.2142 [2468] As one blog commentator remarked, R20;Perhaps a computer model of how to contain R16;flying pigsR17; is in order.R21;2143 [2469] The biggest chink in our armor may be lack of clinical surveillance and rapid detection.2144 [2470] To even theoretically stop a pandemic, the Imperial College model necessitates discovering the incipient pandemic when there are just 30 human cases. In the Emory model, the world would have about 21 days to intervene.2145 [2471] R20;The chances of that happening,R21; admits Secretary Leavitt, R20;are not good.R21;2146 [2472] Countries like Vietnam, Cambodia, and Laos simply donR17;t have the resources needed for adequate surveillance, and even the richer Southeast Asian countries like China, as described by a senior fellow for Global Health at the Council on Foreign Relations,2147 [2473] are R20;completely lacking in sophisticated public health infrastructure.R21;2148 [2474] When bird flu first emerged in Vietnam, for example, the countryR17;s leading analytical centerR12;the National Institute of Hygiene and Epidemiology in HanoiR12;had no safety cabinets, freezers, centrifuges, or incubators, and had to turn to the WHO for a loan. Simple blood tests had to be shipped out of countries for results.2149 [2475] R20;We did not even have masks and gloves,R21; said one virologist at the Institute.2150 [2476] Some countries like Laos had never had a virology lab at all.2151 [2477] The World Health Organization, the World Organization for Animal Health, and the Food and Agriculture Organization of the United Nations came together in 2005 to put out an international plea for funds to help control the disease in poultry populations and detect the disease in human populations. They called for a minimum of $100 million.2152 [2478] R20;Countries in Asia are doing their best to control the virus but they cannot and should not be expected to do this job on their own,R21; said the FAOR17;s chief veterinary officer.2153 [2479] R20;The coming influenza pandemic will cut huge swathes in the world community,R21; professor John Oxford warned, R20;and history will look back with a jaundiced eye should governments hesitate and not join in this war, and place monetary priorities elsewhere.R21;2154 [2480] Said top FAO official Samuel Jutzi, R20;There is an increasing risk of avian influenza spread that no poultry-keeping country can afford to ignore.R21;2155 [2481] Worse than ignoring, countries have actively covered it up. Even if countries could afford proper facilities, many Asian countries have admitted concealing outbreaks, in part, to protect poultry industry interests. R20;An obvious major weak spot in global surveillance,R21; the director of the Australian National Centre for Epidemiology and Population Health points out, R20;is the tendency of national governments to deny or suppress information.R21;2156 [2482] Thailand presents a good case study.2157 [2483] (c) BirdFluBook.com | Home [2484] | Website by Lantern Media [2485] Bird Flu - Thai Curry Favor with Poultry Industry BirdFluBook.com [2486] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2487] Thai Curry Favor with Poultry Industry State agriculture officials staged photo opps With between 30,000 and 50,000 birds commonly found in each unit on intensive poultry farms, mass culling means significant financial loss.2158 [2488] There are facilities in Thailand reported to each have more than ten million chickens.2159 [2489] According to the Thai Broiler Association, Thailand was the worldR17;s fourth-largest poultry exporter before bird flu hit,2160 [2490] producing more than a million tons of meat every year and generating four billion in U.S. dollars in revenue.2161 [2491] At the center of the meltdown of ThailandR17;s poultry industry is 61-year-old multibillionaire Dhanin Chearavanont, profiled in Time magazineR17;s R20;The Families That Own Asia,R21;2162 [2492] who brought the U.S.-style industrial chicken farming pioneered by Tyson to Thailand2163 [2493] more than 20 years ago, transforming a small family business into a multinational corporate empire.2164 [2494] Chearavanont was the Thai tycoon caught making an illegal $250,000 donation to the U.S. Democratic National Committee in 1996. Not to be partisan, he stands accused of slipping former George H. W. Bush a quarter-million dollars as well.2165 [2495] In November 2003, chickens started dying across Thailand. Senator Malinee Sukavejworakit, a medical doctor and representative of one of the worst affected provinces, became concerned. The government assured her that it was just chicken choleraR12;a disease with no human health implicationsR12;and therefore nothing to worry about. The third week of January, she got a call from a physician colleague about a local butcher dying with classic bird flu symptoms. The senator visited him in the hospital. R20;He told me heR17;d been butchering chickens on a farm and heR17;d come across a whole lot of birds with insides like heR17;d never seen,R21; she said. R20;They smelled rancid.R21; She visited the devastated farm. R20;[W]hatever this is,R21; the farmer told her, R20;it isnR17;t cholera.R21; When the Public Health Department refused to release the butcherR17;s test results, she decided to go public.2166 [2496] As chief advisor for the Senate Committee on Public Health, Sukavejworakit convened a meeting and held a press conference the next day. For her efforts to expose the truth, the Deputy Agriculture Minister accused her of being R20;irresponsible to the motherland.R21; The Prime Minister himself dismissed the idea of a bird flu epidemic as R20;fantasy and imagination,R21; warning that such R20;exaggeration will damage the countryR17;s poultry exports and leave chicken farmers and workers in the field to suffer.R21;2167 [2497] Chearavanont wasnR17;t suffering, though. Throughout the crisis, while birds were dying, corporate processing plants were working overtime. R20;Before November we were processing about 90,000 chickens a day,R21; trade unionists explained to the Bangkok Post after the scandal broke. R20;But from November to January, we had to kill about 130,000 daily. ItR17;s our job to cut the birds up. It was obvious they were ill: their organs were swollen. We didnR17;t know what the disease was, but we understood that the management was rushing to process the chickens before getting any veterinary inspection. We stopped eating [chicken] in October.R21;2168 [2498] Later it was divulged that the nationR17;s veterinary scientists had been detecting and reporting H5N1 for months to ThailandR17;s Livestock Department, but as one senator alleges, R20;All the academics and experts had to shut up due to political interference.R21;2169 [2499] The Bangkok press found evidence that the government had been colluding with Big Poultry2170 [2500] to hide the epidemic to give exporters time to process and sell diseased inventory.2171 [2501] An editor at the Bangkok Post later explained to a group of journalists why the press didnR17;t pick up on the cover-up sooner. R20;Our tendency is just to report what people are saying and rely too much on the government,R21; she said. R20;As it turned out, the government was suppressing the truth.R21;2172 [2502] The international community was not surprised. R20;The bottom line is, economic considerations are what dictate the responses of the governments trying to ensure the consequences of avian outbreak is minimized,R21; said WHOR17;s representative in Thailand. R20;ThatR17;s understandable, but itR17;s more important that sufficient measures are taken to prevent humans from catching the disease.R21;2173 [2503] A six-year-old boy was the first to die of H5N1 in Thailand. R20;The government knew,R21; his father said, R20;so why didnR17;t they tell the public so that we could protect ourselves?R21;2174 [2504] This scenario was repeated throughout the region. An outbreak in Japan was concealed by poultry company officialsR12;two of whom later committed suicide2175 [2505] R12;and only came to light thanks to an anonymous tip. The Japan Times editorialized that the factory farmR12;one of the largest in the areaR12;was apparently R20;concerned more about profit than safety.R21;2176 [2506] After IndonesiaR17;s national director of animal health disclosed to the Washington Post that pressure from the poultry industry forced the government to hide its outbreak for more than a year, she was fired. When UN officials complained about the dismissal, the Agriculture Minister replied, R20;The thing is, we donR17;t want to publicize too much about bird flu because of the effect on our farms. Prices have dropped very drastically.R21;2177 [2507] He withheld information, he explained, because R20;we did not want to cause unnecessary losses through a hasty decision.R21;2178 [2508] The deputy director of Focus on the Global South, a nonprofit advocacy organization, summed up the Thailand scandal: The government handling of the bird flu is a saga of cover-ups, incompetence, lies and extremely questionable decisions: the long delay before admitting the existence of the bird flu both in animals and in humans, the selective measures taken to stop the spread of the epidemic and most spectacularly, the massive public relations campaigns to convince Thai citizens that eating chicken was nothing less than a patriotic act.2179 [2509] The director is referring to numerous PR stunts across the region. The Thai government gathered celebrities2180 [2510] for free R20;chicken eating festivals,R21;2181 [2511] and Kentucky Fried Chicken in Thailand gave away 50,000 pieces of chicken.2182 [2512] In China, the executive vice minister of healthR12;a vegetarianR12;ate chicken for the first time in 30 years to proclaim its safety. ChinaR17;s main propaganda unit acknowledged that the staged meals suggested an official shift R20;from traditional propaganda to Western-style political communications skills to handle crises.R21;2183 [2513] The strategy was perhaps made most famous by the British Minister of Agriculture who was shown on television feeding a hamburger to his four-year-old daughter while reassuring the public with the blanket statement that eating beef was R20;perfectly safe,R21; a few short years before young people started dying from mad cow disease.2184 [2514] Not all such media events had the desired effect. At a cull ceremony at a pig farm in Indonesia, the Minister of Agriculture showed up in a special white outfit complete with gloves and mask, surprising the staffers, reporters, and hundreds of locals who wore no protective gear at all. R20;DonR17;t blame me if you get bird flu because you donR17;t wear a mask. This is very dangerous, you know, as the virus can be transmitted through the air,R21; he warned reporters through his mask.2185 [2515] The official state cover-ups surrounding bird flu remind many of the SARS debacle in China. All occurrences of infectious disease outbreaks were considered official state secrets; physicians or journalists caught disclosing SARS-related information to their friends were arrested under the official State Secrets Law.2186 [2516] By the time China finally admitted there was a problemR12;months after the first discovered caseR12;there were already hundreds of people infected.2187 [2517] In general, said a WHO spokesperson, R20;Economics and agriculture are weighing too heavily in decisions taken by governments, and more concern should be given to the risk to human health.R21;2188 [2518] This is one of the reasons that the prospect of ring-fencing an influenza pandemic in time is so remote. R20;If they would have acknowledged this [SARS] early, and we could have seen the virus as it occurred in south China, we probably could have isolated it before it got out of hand,R21; explained one infectious disease expert. R20;But they completely hid it. They hide everything. You canR17;t even find out how many people die from earthquakes.R21;2189 [2519] The foundation of the theoretical models is openness and cooperation for rapid detection of outbreaks of influenza. R20;Would they admit to it if it was here?R21; one Asian diplomat asked. R20;ThatR17;s the big question, since they deny everything left, right and center.R21;2190 [2520] Reluctance to share data seems a universal phenomenon. In an article in the journal Science titled, R20;Flu Researchers Slam U.S. Agency for Hoarding Data,R21; international scientists claim that getting data from the CDC is somewhere between R20;extremely difficult and impossible.R21;2191 [2521] R20;The CDC is not the CIA,R21; the director of the Federation of American ScientistsR17; project on government secrecy said. R20;Withholding data is not just bad public policy, it is bad science.R21;2192 [2522] During a 2004 outbreak of low-grade bird flu in Delaware and Maryland, state authorities refused to release the identity of the affected poultry operations. R20;The stigma attached to having an infectious disease is real,R21; explained one North Carolina State University veterinarian in Poultry International,2193 [2523] R20;and often leads people to keep this information from others.R21; A spokesperson for the group Common Cause in Delaware, however, disagreed with the policy. R20;When youR17;re talking about a worldwide problem, you really canR17;t keep things secret even if you think itR17;s good public policy. People want to know, and they want their government agencies to be honest, open and transparent.R21;2194 [2524] Even when governments try to do the right thing, the populace may not go along. When H5N1 hit turkeys in Turkey, the order, R20;Bring your poultry to the town square this evening for slaughter,R21; blared from town hall speakers. R20;Failure to comply could mean up to six months in jail.R21;2195 [2525] When authorities went to forcibly round up ducks and chickens in the region they were reportedly met by hostile farmers armed with pitchforks and axes.2196 [2526] Part of the problem may be that existing international law on infectious disease control is archaic, formed a half-century ago before mass global travel. The World Health Organization, for example, can only issue R20;soft lawR21; recommendations, rather than binding obligations. This outmoded system of international relations in general dates back to the 17th-century Peace of Westphalia ending the Thirty Years War. The Westphalian system is built upon the principle of absolute national sovereignty.2197 [2527] R20;Many governments see it [disease prevention] as an internal business,R21; said the WHOR17;s Director-General. R20;There is a basic gut feeling that this is my problem, I will deal with it in my way. Now, in a globalized world, any disease is one airplane away. It is not a provincial or national issue, itR17;s a global issue.R21;2198 [2528] The World Trade Organization has more powers than the World Health Organization.2199 [2529] Analogous to FEMA during the Katrina crisis, the WHO also lacks the authority to investigate outbreaks without an invitation.2200 [2530] For SARS, though, the WHO did issue the first travel advisory in its 55-year history.2201 [2531] The ensuing political backlash over lost trade and tourism may explain some of the deference to member nations in somewhat downplaying the immediacy of the current pandemic threat.2202 [2532] Finally, some argue, the WHO is under-funded, with an annual core budget of $400 million. By comparison, the annual budget of New York CityR17;s health department exceeds $1.2 billion.2203 [2533] In the understated fashion typical to international law journals, one review concluded, R20;The soft law process on infectious disease control has not been working well.R21;2204 [2534] (c) BirdFluBook.com | Home [2535] | Website by Lantern Media [2536] Bird Flu - R20;We have as much chance of stopping a pandemic as we would of putting a curtain around Minnesota and keeping out winter.R21; BirdFluBook.com [2537] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2538] R20;We have as much chance of stopping a pandemic as we would of putting a curtain around Minnesota and keeping out winter.R21; R12;Michael Osterholm2205 [2539] Michael Osterholm on the Oprah Winfrey Show Even assuming that countries had the resources for proper surveillance and reported outbreaks promptly, no antiviral stockpile currently exists to carry out the ring-fencing strategy. The WHO only has 120,000 courses of antivirals, whereas millions may be necessary.2206 [2540] The WHO sent 2,500 treatments to Vietnam, 500 to Cambodia,2207 [2541] and a few hundred courses divided among 44 hospitals in Indonesia; many received no more than a handful.2208 [2542] Countries at risk, like Sri Lanka, report they donR17;t have a single dose.2209 [2543] R20;I think the take-home message,R21; said an epidemiologist at Harvard, R20;is that the current stockpile is very unlikely to be adequate to stop anything.R21;2210 [2544] Meanwhile, the Western world is continuing in its R20;narcissistic planning,R21;2211 [2545] as described in a medical journal editorial, ignoring pleas from the World Health Organization to pour resources into Southeast Asia.2212 [2546] The United States may spend $1 billion to domestically stockpile antiviral drugs.2213 [2547] ThatR17;s more than ten times the entire health budget for Vietnam. In Cambodia, the total annual budget for a campaign to encourage citizens to report suspected cases of bird flu is about $3,000.2214 [2548] In a New Yorker interview, a senior public health official pondered the question of whether countries in the West might send their resources to combat the flu in Southeast Asia. He told the reporter, R20;Who are you kidding?R21;2215 [2549] In the end, mathematical models remain just thatR12;mathematical models. Even assuming that the models are valid, they are so qualified with conditional assumptions as to potentially render them useless under real world conditions. Public health experts point out that the odds are vanishingly slim of early detection of a small cluster in a rural area with little public health infrastructure followed by the distribution of an antiviral stockpile that doesnR17;t yet existR12;all within a three-week period.2216 [2550] Michael Osterholm, who was responsible for leading the single-largest containment campaign in U.S. history to control a meningitis outbreak,2217 [2551] is skeptical that influenza can be stopped: R20;To believe that you can contain this locally is to believe in fairy tales.R21;2218 [2552] Poorly executed, the strategy could even make things worse by creating Tamiflu resistance in the virus that escapes. This class of drugs represents our last remaining hedge against the pandemic.2219 [2553] R20;We have to be very careful right now,R21; warns one University of Hong Kong microbiologist. R20;We donR17;t want a lot of drug resistance for Tamiflu because if the pandemic comes, it may become uselessR30;[and] we will then be completely disarmed. We will be finished, this is the concern.R21;2220 [2554] Even if the human pandemic could be successfully quashed, we might still face a R20;reloadingR21; problem. Experts speculate that H5N1 could be so endemically entrenched within multiple, globe-trotting migratory species of birds that its eradication must be regarded as impossible, presenting a constant pool of mutant virus ready to pop up somewhere else. In bird populations, we are dealing with a moving target.2221 [2555] The genie cannot be put back in its bottle. Given these considerations, a microbiologist at Chinese University sums up the bottom line: R20;[O]nce H5N1 becomes easily transmissible in humans, it will be the end,R21; he said. R20;We can do nothing to control this spreading.R21;2222 [2556] (c) BirdFluBook.com | Home [2557] | Website by Lantern Media [2558] Bird Flu - R20;He who desires, but acts not, breeds pestilence.R21; BirdFluBook.com [2559] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2560] R20;He who desires, but acts not, breeds pestilence.R21; R12;William Blake Too little too late? For years, scientists have requested detailed operational blueprintsR12;country by country down to neighborhood by neighborhoodR12;on how best to make it through 12 to 24 months of a pandemic.2223 [2561] R20;If the greatest pandemic in history is indeed on the horizon,R21; wrote the editorial board of Lancet, R20;that threat must be met by the most comprehensive public-health plan ever devised.R21;2224 [2562] Indeed, Senator Majority Leader Frist has called for an unprecedented effort rivaling the Manhattan Project in scope and intensity to prepare the nationR17;s defenses.2225 [2563] R20;We have only one enemy,R21; CDC director Gerberding has said repeatedly, R20;and that is complacency.R21;2226 [2564] Unfortunately, no country is prepared.2227 [2565] In the policy journals like Foreign Affairs, senior officials admit that planning for what they call R20;the most catastrophic outbreak in human historyR21; is R20;abysmally inadequate.R21;2228 [2566] Despite repeated warnings over the years that a new pandemic is inevitable and repeated prods by the WHO for countries to draw up preparedness plans, only about 50 of more than 200 countries have done so.2229 [2567] Some of these R20;plansR21; are as stunted as a single page2230 [2568] and most, as described in the science journal Nature, are R20;very sketchy.R21;2231 [2569] The WHO calls for countries to R20;put life in these plansR21; by carrying out practice simulations. R20;One has to be very vigilant, honest and brave,R21; asserts Margaret Chan, now the WHOR17;s chief of pandemic preparedness. R20;Sometimes you need to make unpopular, difficult recommendations to political leaders which may have a short-term impact on the economy and on certain sectors.R21;2232 [2570] As the Los Angeles County Disaster Preparedness Task Force motto reads, R20;The only thing more difficult than preparing for a disaster is trying to explain why you didnR17;t.R21;2233 [2571] Fewer than 10% of the countries with plans have taken the necessary further step of translating the plans into national law.2234 [2572] The chair of the Infectious Disease Society of AmericaR17;s Pandemic Influenza Task Force is concerned about the state of U.S. preparedness. R20;Although many levels of government are paying increased attention to the problem,R21; he said, R20;the United States remains woefully unprepared for an influenza pandemic that could kill millions of Americans.R21;2235 [2573] Osterholm was, as usual, more direct. R20;If it happens tonight,R21; Osterholm said at a forum sponsored by the Council on Foreign Relations, R20;weR17;re screwed.R21;2236 [2574] Osterholm laid it out on The NewsHour with Jim Lehrer: R20;We can predict now 12 to 18 months of stress, of watching loved ones die, of potentially not going to work, of wondering if youR17;re going to have food on the table the next day. Those are all things that are going to mean that weR17;re going to have to plan unlike any other kind of crisis that weR17;ve had in literally the last 80-some years in this country.R21;2237 [2575] The U.S. pandemic preparedness plan has been long in the making. The planning process started in 1976, only to become one of the longest-standing incompleted processes in Washington.2238 [2576] Various drafts emerged in R17;78 and R17;83, but were reshelved and forgotten until the latest effort to update and implement such a plan began in 1993.2239 [2577] The Government Accountability OfficeR12;the watchdog arm of CongressR12;scolded the Department of Health and Human Services on six separate occasions for failing to develop a national response plan despite many years of R20;process.R21;2240 [2578] In October 2005, a draft of the plan was obtained by the New York Times. The R20;preparedness planR21; highlighted how poorly prepared the country is for a pandemic. The headline read, R20;U.S. Not Ready for Deadly Flu, Bush Plan Shows.R21;2241 [2579] In the Boston Globe, Massachusetts Senator Edward Kennedy noted that other nations like Canada, Britain, and Japan had completed their plan a year or years before. R20;TheyR17;re putting their plans into action right now,R21; Kennedy wrote, R20;while weR17;re waiting to read ours for the first time. America deserves better.R21;2242 [2580] Senator Arlen Specter agreed. R20;Could we have acted sooner to avoid the situation we are in now, in effect running for cover?R21; he asked. R20;We need a better way of finding out what the hell is going on.R21;2243 [2581] One of the factors blamed for the 29-year delay in producing a plan was the difficulty of interdepartmental coordination. A pandemic would impact all agencies of government, but they donR17;t all have the same priorities. Senior policy analysts describe the Department of Agriculture and the Department of Health and Human Services, for example, as R20;not exactly good bedfellows.R21; The USDAR17;s traditional mission to defend the economic interests of the agricultural industry sets up a natural tension with agencies prioritizing broader concerns.2244 [2582] Experts predict the economic impact on U.S. agriculture will be nothing compared to the havoc wreaked by the virus more generally.2245 [2583] The official plan was finally released in November 2005. The CDC planners did not mince words: R20;No other infectious disease threat, whether natural or engineered, poses the same current threat for causing increases in infections, illnesses, and deaths so quickly in the United States and worldwide.R21;2246 [2584] In terms of preparedness, though, the New York Times editorialized that it R20;looks like a prescription for failure should a highly lethal flu virus start rampaging through the population in the next few years.R21; The editorial noted that experts find the plan R20;disturbingly incomplete,R21; particularly because it R20;largely passes the buck on practical problemsR21; to state and local authorities, R20;none of which are provided with adequate resources to handle the job.R21;2247 [2585] Redlener called it "the mother of all unfunded mandates."2248 [2586] Laurie Garrett of the Council on Foreign Relations has long advocated an integrated public health infrastructure. R20;If such an interlaced system did not exist at a time of grave need it would constitute an egregious betrayal of trust,R21; she wrote in a book bearing the same name, Betrayal of Trust: The Collapse of Global Public Health.2249 [2587] (c) BirdFluBook.com | Home [2588] | Website by Lantern Media [2589] Bird Flu - Chicken Little Gets the Flu BirdFluBook.com [2590] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2591] Chicken Little Gets the Flu Unused swine flu vaccine Another impediment to progress may have been the reluctance of authorities to appear as though they were sowing undue panic among the populace. The U.S. government has not yet involved the public to any significant degree.2250 [2592] Many of the Congressional briefings on H5N1 and pandemic preparedness have been classified as R20;Top Secret/Sensitive Compartmented Information.R21; This does not sit well with Columbia UniversityR17;s Irwin Redlener. R20;This is old-fashioned cold war secrecy being applied to a public-health issue,R21; he said, R20;a very bad idea.R21;2251 [2593] Bureaucratic tendencies toward condescension are not limited to the United States. The London Times ran a story describing an emergency meeting of 25 European states to deal with the threat of H5N1 at which they urged citizens not to be panicked by bird flu.2252 [2594] In response, Effect Measure [2595] , the leading public health blog dealing with avian influenza, wrote, R20;I donR17;t know about you, but the one thing that makes me want to panic is when the leaders of 25 countries meet in emergency session and tell me not to panic.R21;2253 [2596] Similar attempts to placate the public were made 88 years ago. A year after California Senator Hiram Johnson coined the famous phrase, R20;The first casualty when war comes is truth,R21;2254 [2597] public officials were publicly lying to downplay the 1918 pandemic so as not to undermine the war effort.2255 [2598] One of the leading pandemic historians notes how this resulted in a public backlash: People could see while they were being told on the one hand that itR17;s ordinary influenza, on the other hand they are seeing their spouse die in 24 hours or less, bleeding from their eyes, ears, nose and mouth, turning so dark that people thought it was the black death. People knew that they were being lied to; they knew that this was not ordinary influenza.2256 [2599] According to historians, the first reaction of most authorities during the 1918 pandemic was R20;just flat-out denial.R21;2257 [2600] The Chief Health Officer of New Zealand told the papers to R20;tell your readers not to get upset.R21; RomeR17;s Chief Sanitation Officer belittled the flu as a R20;transitory miniscule phenomenon.R21; PolandR17;s Public Health Commission and RhodesiaR17;s Medical Director issued the identical bromide: R20;There is no cause for alarm.R21;2258 [2601] TorontoR17;s Medical Officer was saying, R20;There is absolutely no necessity for anxiety,R21; even as the plague arrived on their doorsteps,2259 [2602] echoing the Health Commissioner of New York City: R20;The city is in no danger of an epidemic. No need for our people to worry.R21;2260 [2603] The resulting mistrust of government officials only added to the climate of fear, a scenario modern-day officials are in danger of repeating.2261 [2604] R20;That men do not learn very much from the lessons of history,R21; Aldous Huxley once said, R20;is the most important of all the lessons that history has to teach.R21;2262 [2605] One factor that may be affecting U.S. officials in particular is memories of the so-called R20;swine flu debacleR21; of 1976, in which tens of millions of Americans were vaccinated against a supposed pandemic strain of influenza that never materialized. Not only was the CDC left with 90 million useless doses of vaccine,2263 [2606] but several of those vaccinated suffered life-threatening side effects2264 [2607] resulting in thousands of lawsuits being filed, hundreds of which were settled for a total of millions of dollars.2265 [2608] The resulting political fiasco led to the firing of the heads of the CDC and the Department of Health.2266 [2609] What makes the threat of H5N1 different from the presumed threat of swine flu in 1976? How can U.S. officials be certain that bird flu is not another Chicken Little scenario? The critical difference is the current global scientific consensus that H5N1 may represent a genuine pandemic threat. Back in 1976, authorities throughout the worldR12;including the World Health OrganizationR12;disagreed with the United States that the death of a single soldier from a swine influenza virus warranted universal vaccination. They thought America was overreacting.2267 [2610] But now the worldR17;s authorities are in agreement. As summarized by Lee Jong-wook, the late Director-General of the World Health Organization, H5N1 is a R20;grave danger for all people in all countries.R21;2268 [2611] This is a role public health officials donR17;t relish. R20;I do not want to be right,R21; said the WHOR17;s Lee Jong-wook. R20;I do not want to be seen as a prophet of doom,R21; said the European Commissioner for Health and Consumer Protection. R20;But I am obliged to ring the alarm bellR30;.R21;2269 [2612] R20;WeR17;re not scare-mongering here,R21; avowed CanadaR17;s top expert, head of the national microbiology lab. R20;WeR17;re not crying wolf,R21; he said. R20;There is a wolf. We just donR17;t know when itR17;s coming.R21;2270 [2613] In reference to public health officials who fear they will be accused of alarming people unnecessarily, one risk communications expert reminded a reporter, R20;They forget that in the actual Boy Who Cried Wolf story, the wolf finally showed up.R21;2271 [2614] Lee Jong-wook insisted that every country must have not only a national pandemic response plan, but also a communications strategy to keep the public informed as to what is happening and what they can do without causing panic.2272 [2615] Communicating public health risks, though, Osterholm says, is like driving with both feet. R20;YouR17;re putting one foot on the gas and the other on the brake. You want to motivate on the one hand, and not cause panic on the other.R21;2273 [2616] Not wanting to cause panic is admirable, but in a country not infrequently alerted in response to formless terrorist threats, it would seem appropriate to inform about threats that are considered both real and imminent.2274 [2617] The CDCR17;s National Immunization Program associate director for communications doesnR17;t believe it possible to effectively motivate people to take appropriate precautions against health risks without making them feel at least some level of concern or anxiety. R20;This is like breaking up with your boyfriend without hurting his feelings,R21; the director said. R20;It canR17;t be done.R21;2275 [2618] R20;DonR17;t be afraid to frighten peopleR21; is considered by WHO risk communication specialists to be a key principle in communicating risks such as H5N1 with integrity.2276 [2619] The director of the Canadian Centre for Health Care Ethics wrote, R20;A concern that public discussion of a probable flu pandemic will cause alarm among the public is not sufficient justification for non-communication, just as concern for a patientR17;s anxiety would not justify not warning him of an impending stroke.R21;2277 [2620] UN Secretary-General Kofi Annan has counseled, R20;If other pandemics have taught us anything, it is that silence is deadly.R21;2278 [2621] It is true that when people are already terrified, scaring them further may push them into denial. In general, however, public opinion polls show that the population remains too apathetic about the threat of bird flu.2279 [2622] A poll in Europe showed that the majority of the population believes that their governments could somehow protect them in the event of a pandemic.2280 [2623] In a WHO publication, the communication experts conclude, R20;We canR17;t scare people enough about H5N1.R21;2281 [2624] One reason bird flu may sound apocryphal is that we donR17;t want to believe thereR17;s something that modern medical science canR17;t handle.2282 [2625] AlbertaR17;s Health Minister is concerned that people donR17;t understand how overwhelmed the health-care system will become. R20;What worries me most is the ignorance of people in the public who assume that if they get sick thereR17;ll be something there for them, and they donR17;t realize the devastation this could be.R21;2283 [2626] The prospect of a pandemic might also just be too disturbing to consciously consider. The same disbelief existed in 1918. From fancy dress balls in the Johannesburg City Hall in Spanish costume emblazoned with R20;Spanish fluR21; to Londoners holding R20;sneezing partiesR21; with a bottle of champagne given as prize to the lustiest sneeze, the citizens of the world in early 1918 ridiculed as a joke the threat of R20;Spanish Influenza.R21;2284 [2627] They were not laughing for long. Media messages about H5N1 have been mixed. Until fall 2005, news of the impending pandemic was practically nonexistent in North America.2285 [2628] Editorial pages slowly started to take notice of the gravity of the situation. The Philadelphia Inquirer editorialized in August that R20;the U.S. policymakers remain amazingly passive about pandemic preparations.R21;2286 [2629] In September 2005, though, bird flu hit prime time. The ABC News Primetime special started with the words, R20;It could kill a billion people worldwide, make ghost towns out of parts of major cities, and there is not enough medicine to fight it. It is called the avian flu.R21;2287 [2630] Finally, the issue was starting to get the coverage it deserved. Then, the media backlash began. Headlines like R20;No Local Threat from Avian FluR21;2288 [2631] or R20;Bird Flu Not Expected to Affect ArkansasR21;2289 [2632] downplayed the global reach by misunderstanding the capacity of the virus to mutate into a human transmissible form. It was framed as strictly a threat to chickens and a few peasant farmers. Meat industry officials the world over said things like, R20;We care about a pandemic. We do care. But so far, there is no scientific evidence of human-to-human transmission.R21;2290 [2633] Of course, by then it will be too late. As the president of the National Academy of Sciences Institute of Medicine has said of the worldR17;s efforts to prepare for pandemic flu, R20;The only reason nobodyR17;s concerned the emperor has no clothes is that he hasnR17;t shown up yet.R21;2291 [2634] R20;ItR17;s still seen by many capital cities in the West as basically a lot of chickens dying and chicken farmers, so they think, where is the urgency?R21; explained the FAO of the United Nations. R20;Our reply is, if this develops into an uncontrollable pandemic in a year, it wonR17;t be farmers dying in the paddy-fields of Vietnam. People will be dying in Washington, New York, London and Paris.R21;2292 [2635] Countries continue to hide their heads in the sand.2293 [2636] The United States is no exception, claims Osterholm, who doubles in his professional life as both director of the Center for Infectious Disease Research and Epidemiology and associate director for the Department of Homeland SecurityR17;s National Center for Food Protection and Defense. R20;This to me is akin to living in Iowa,R21; Osterholm said, R20;and seeing the tornado 35 miles away coming. And itR17;s coming. And itR17;s coming. And itR17;s coming. And it keeps coming.R21;2294 [2637] R20;I worry that too many policy leaders dance around this issue fearful that somehow they will either offend or frighten the public,R21; Osterholm said, answering critics who complain about his dire warnings. R20;Our job is not to upset people or to calm people. Our job is to tell the truth.R21;2295 [2638] R20;I am not trying to scare people out of their wits,R21; he said. R20;I am trying to scare them into their wits.R21;2296 [2639] (c) BirdFluBook.com | Home [2640] | Website by Lantern Media [2641] Bird Flu - Our Best Shot BirdFluBook.com [2642] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2643] Our Best Shot Scarcity sometimes even with seasonal flu vaccine Two months following the Katrina disaster, President Bush proposed a multibillion-dollar spending plan to address the pandemic, allotting much-needed funds to boost antiviral stockpiles and give domestic vaccine production a shot in the arm to improve vaccine technology.2297 [2644] In an unclassified Congressional briefing, Gregory A. Poland of the Mayo Clinic and the Infectious Diseases Society of America said, R20;We and the entire world remain unprepared for what could arguably be the most horrific disaster in modern history.R21; He emphasized, R20;The key to our survival, in my opinion, and to the continuity of government is vaccination.2298 [2645] Officials understand that waiting for the pandemic strain to arise before starting vaccine production would mean a six- to eight-month delay and untold numbers of deaths. Instead of waiting, many experts have advocated making a human vaccine to the current bird-adapted H5N1 in hopes that the current strain will be sufficiently similar to the virus that eventually R20;goes humanR21; for the vaccine to afford at least some protection. The vaccine industry has not been quick to act on this recommendation. In 2004, the editorial board of science journal Nature Medicine asked, R20;Why have we waited so long to develop a human vaccine against avian flu despite evidenceR12;dating back to 1997R12;of human infection?R21;2299 [2646] A year earlier, after another man in Hong Kong died from H5N1, Robert Webster put it flatly: R20;WeR17;ve had H5N1 since 1997, yet we donR17;t have a vaccine on the shelf. That is a black eye for WHO and the system. What the hell have we been doing?R21;2300 [2647] Despite years of lost lead time, in August 2005, the development of an H5N1 vaccine was announced. The New York Times ran an exclusive in its Sunday edition trumpeting, R20;Avian Flu Vaccine Called Effective in Human Testing.R21; The story of a human H5N1 vaccine was picked up by the Associated Press and echoed with titles like R20;Vaccine Appears to Ward Off Bird Flu.R21;2301 [2648] These feel-good, R20;hope is on the wayR21; stories may have led to a nationwide collective sigh of relief. Unfortunately, the story was effectively retracted days later2302 [2649] as details emerged.2303 [2650] The announcement was based on a small clinical study showing that healthy volunteers injected with a vaccine made from a single Southeast Asian strain of H5N1 (not the one that escaped from China into Russia and winged its way to Western Europe) did seem to make antibodies against the virus. Unfortunately, this response does not necessarily translate into protection from disease. Other experimental influenza vaccines have similarly raised antibodies but paradoxically led to increased severity of disease and mortality in vaccinated animals in laboratories.2304 [2651] Even if this vaccine is effective in reducing mortality from the avian strain utilized and the imminent human pandemic virus, the researchers discovered that the dose required to elicit the immune response was so huge as to make global production impractical.2305 [2652] To Osterholm, the results suggest that the world is even less prepared than previously thought.2306 [2653] R20;You know how you creep, then you walk, then you run?R21; Osterholm asked. R20;WeR17;re still on our knees.R21;2307 [2654] Annual flu vaccines typically only require a single shot of 15 micrograms (µg) of killed virus protein, since people already have a low level of pre-existing immunity to similar strains from past flu seasons.2308 [2655] Essentially no one, though, has any natural immunity to H5 viruses.2309 [2656] The researchers reported that a massive vaccination doseR12;two separate injections of 90µgR12;would be required. Twelve times the standard dose of regular flu vaccine means 12 times fewer vaccine doses can be produced. R20;Needing two doses of 90µg is the worst-case scenario,R21; noted a leading virologist. R20;You are not going to get very far with that.R21;2310 [2657] The U.S. production capacity for seasonal flu vaccines is 180 million doses. Two doses of 90 µg would mean that if the entire U.S. production system was devoted entirely to making pandemic vaccine, it could only produce enough to protect 15 million people, barely 5% of the U.S. population.2311 [2658] Globally, the situation is worse. At the concentration required, the worldR17;s vaccine producers straining at full capacity could only cover about 1% of the planetR17;s population. R20;There is now a tremendous anxiety among scientistsR12;including meR12;about this,R21; said Professor Peter Dunnill, chairman of the Advanced Centre for Biochemical Engineering at University College, London. R20;Instead of providing protection for up to a billion people across the world, we will be lucky to get enough doses to vaccinate a few dozen million.R21;2312 [2659] A WHO official asked, R20;WhoR17;s going to get the limited antivirals and vaccines that do become available? And how do we live with people who donR17;t? What do we say to them?R21;2313 [2660] As one researcher described it in Science, R20;ItR17;s a vaccine for the happy few.R21;2314 [2661] R20;The good news is, we do have a vaccine,R21; Secretary Leavitt told CBS NewsR17; The Early Show.2315 [2662] R20;It doesnR17;t matter if we have a vaccine now or not,R21; Osterholm exclaimed in a telephone interview. R20;We canR17;t make it.R21;2316 [2663] ItR17;s not enough to produce a vaccine; it must be mass produced.2317 [2664] Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, describes the R20;critical issue nowR21; as, R20;Can we make enough vaccine, given the well-known inability of the vaccine industry to make enough vaccine?R21;2318 [2665] R20;For those of us who do this and think about it every day, all day,R21; Fauci continued, R20;even if we could and wanted to and made the decisionR12;this is what we needR12;the capacityR17;s not there.R21;2319 [2666] This begs the question, why not? Why arenR17;t there more dedicated factories? Why does the vaccine distribution system allegedly remain R20;broken, both technically and financially?R21;2320 [2667] Why is the manufacturing processR12;as an expert summed up in a wordR12;R20;lousy?R21;2321 [2668] Two-time Pulitzer Prize-winning journalists Donald L. Barlett and James B. Steele have been called by the Washington Journalism Review R20;almost certainly the best team in the history of investigative reporting.R21;2322 [2669] They took on these questions for the seasonal flu shots in a New York Times editorial and laid blame on the privatization of vaccine production. R20;Preventing a flu epidemic that could kill thousands,R21; they wrote, R20;is not nearly as profitable as making pills for something like erectile dysfunction.R21;2323 [2670] Bringing a vaccine to market may cost drug companies close to $1 billion;2324 [2671] thatR17;s how much money Viagra alone brings in every year.2325 [2672] Ideally vaccines are R20;one shot deals,R21; unlike medications more profitably taken long-term.2326 [2673] R20;ItR17;s basically the corporate model working,R21; said a flu expert at the University of Michigan. R20;You put your money where the blockbusters are.R21;2327 [2674] Industry insiders agree. David Fedson, a former director of medical affairs for a major vaccine manufacturer, notes, R20;We have a toxic mixture in America of a corporate culture that is inappropriate for producing vaccines for national security and a political culture that is unwilling to accept government responsibility for ensuring it is achieved.R21; R20;Our corporate culture demands a 15R11;25% annual net return on sales,R21; he said, R20;which life-saving commodity products such as vaccines never attain.R21;2328 [2675] Lacking adequate domestic vaccine production, Americans may find themselves at the end of the line when the pandemic breaks.2329 [2676] The few U.S. vaccine manufacturers produce most of their vaccine overseas in countries that could nationalize production facilities and claim first dibs.2330 [2677] We acted in much the same way in 1976; anticipating a swine flu pandemic, the United States refused to share any of its vaccine.2331 [2678] R20;It is sheer folly,R21; one doctor wrote, R20;to expect overseas sourcing [of a vaccine] as an option.R21;2332 [2679] The rest of the world would be left even worse off. At present, 90% of production capacity for all influenza vaccines is concentrated in European and North American countries that account for only 10% of the worldR17;s population.2333 [2680] R20;If there is an epidemic of bird flu and people start dying in the proportion people believe, I donR17;t think goodwill is going to be an issue,R21; said a former chairman of the Food and Drug AdministrationR17;s vaccine advisory committee. R20;ItR17;s going to be every man for himself.R21;2334 [2681] Acknowledging a R20;compelling national interest for a vaccine manufacturing capacity to exist,R21; the Bush administrationR17;s answer is to provide incentives and subsidies R20;ranging from liability insurance to better profit marginsR21; for the pharmaceutical giants that produce vaccines.2335 [2682] R20;Otherwise,R21; Secretary Leavitt explains, R20;they have competing demands for their capital that make more sense for them to pursue.R21;2336 [2683] The potential saving of millions of lives is evidently not a R20;compelling national interest.R21; NatureR17;s senior reporter comments: R20;When the military knows it needs a fighter aircraft, it doesnR17;t offer incentives to Lockheed Martin or Boeing. It pays them through procurement to develop the weapon to the specifications it wants.R21;2337 [2684] Scientists are currently working on a way to decrease the required dose of H5N1 vaccine by adding a chemical adjuvantR12;a substance that nonspecifically irritates the immune system and may boost the immune response to the vaccine.2338 [2685] Said one vaccine expert: It is possible we could improve dosage levels, but legal disputes over manufacturing rights, problems of scaling up manufacturing, arguments about who owns vaccines made in a given country and many other problems will also affect vaccine manufacture. We will be lucky to get enough vaccine to protect the public against avian flu in the next five years. We should therefore be quite clear: the chances of stopping a flu pandemic before 2010 are going to be extremely slim.2339 [2686] Others are pushing for more radical solutions. R20;The current vaccine system is not going to work,R21; says Professor Dunnill. R20;We need a new approach.R21;2340 [2687] That new approach is cell-culture, rather than egg-based, vaccine production. One artifact of the current system is that when viruses are grown in eggs for certain types of vaccines, the viruses may adapt to the infection of eggs, rather than the infection of humans. Growing the virus directly in cultures of human cells precludes this possibility.2341 [2688] Also, according to the director of the FDAR17;s Center for Biologics Evaluation and Review, growing vaccine virus in culture not only eliminates the need for hundreds of millions of fertile chicken eggs, but is expected to increase the flexibility, yield, and speed of vaccine production.2342 [2689] President BushR17;s 2006 veto on stem cell research, though, may hinder research on cell culture-based vaccines,2343 [2690] some of whichR12;like SabinR17;s famous polio vaccineR12;use fetal tissue.2344 [2691] Efforts to upgrade and expand domestic vaccine production continue in the United States, but are expected to take years to have an effect.2345 [2692] Asked if it was too late to prepare for the coming pandemic, vaccine industry insider Fedson replied, R20;ItR17;s always too late, and itR17;s never too soon. But weR17;ve got to start somewhere.R21;2346 [2693] (c) BirdFluBook.com | Home [2694] | Website by Lantern Media [2695] Bird Flu - R20;Access to medicines has become the test above all others by which the rich world will be judged in its dealings with the poor.R21; BirdFluBook.com [2696] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2697] R20;Access to medicines has become the test above all others by which the rich world will be judged in its dealings with the poor.R21; R12;Richard Horton2347 [2698] In the months the pandemic is expected to rage before a vaccine is available, an elite segment of the privileged world will have antiviral drugs like Tamiflu, and the rest of the world will essentially have nothing. A lead article in the Medical Journal of Australia pointed out the irony that the countries in the region most likely to become sources of the pandemic strain are the ones least able afford to a national Tamiflu stockpiling strategy.2348 [2699] Webster remembers a trip he made to brief prime ministers of the Association of Southeast Asian Nations on what the rest of the world could offer them. He told them that the World Health Organization will try to help with the initial outbreak. R20;But if it breaks through, guys,R21; he said, R20;youR17;re on your own.R21;2349 [2700] Mike Davis in his landmark bird flu book, The Monster at Our Door, describes this as the R20;Titanic Paradigm.R21; He compares the availability of the worldR17;s public health resources to that of lifeboats on the Titanic: R20;[M]any of the first-class passengers and even some of the crew will drown because of the companyR17;s skinflint lack of foresight; the poor Paddies in steerage, however, do not even have a single lifeboat between them, and thus, they are all doomed to swim in the icy waters.R21;2350 [2701] Symbolic gestures are at least being made. Australia sent a stockpile of 50,000 treatments of Tamiflu to Indonesia, population 211,000,000.2351 [2702] The rest of the stockpile in the region is hidden in R20;secure locations,R21;2352 [2703] sites remaining secret R20;for national security.R21;2353 [2704] Canada has signed a pledge announced by Mexico for wealthy nations to donate 10% of their flu drug stockpile and eventual vaccines to less affluent nations.2354 [2705] R20;Just imagine the ethical, political and security implications of a world where only rich countries have access to lifesaving drugs or vaccines, and the rest of the world stands while [poor countries] march toward death,R21; MexicoR17;s Health Minister told the Canadian Press. R20;That is an unsustainable scenario.R21;2355 [2706] Garrett agrees that these disparities during a global crisis bring up R20;desperate, unbelievably enormous foreign policy issuesR21;2356 [2707] and could turn into a R20;big bloody mess.R21;2357 [2708] The United States declined to sign onto the same pledge. Given limited U.S. supplies, it would be R20;unrealistic,R21; said a senior advisor with the U.S. Emergency Preparedness Department, R20;to start talking about sharing.R21;2358 [2709] (c) BirdFluBook.com | Home [2710] | Website by Lantern Media [2711] Bird Flu - Patent Nonsense BirdFluBook.com [2712] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2713] Patent Nonsense Pharmaceutical giant Roche owns the license to produce Tamiflu and thereby exacts monopoly pricing by historically controlling the global supply through its single Tamiflu factory in Switzerland. Countries such as France, Australia, and New Zealand each have Tamiflu stockpiles expected to cover 20% of their national populations, at a cost of about 1% of their annual health budgets. An equivalent stockpile would account for 28% of ChinaR17;s annual health budget, 54% of CambodiaR17;s, 67% of IndonesiaR17;s, 75% of VietnamR17;s and 173% of LaosR17;. R20;At the current prices,R21; the researchers who performed the calculations concluded, R20;it is unlikely that many countries will be able to afford it.R21;2359 [2714] Meanwhile, Roche is feathering its nest with windfall profits from the bird flu drug, with 2005 third-quarter group sales approaching $20 billion.2360 [2715] Roche is no stranger to price fixing. In 1999, the corporation pleaded guilty to a worldwide conspiracy to form a cartel to criminally R20;raise, fix and maintainR21; prices for vitamins sold in the United States and elsewhere. Roche was fined $500 million. According to the U.S. Department of Justice, this record fine was the highest criminal fine in history.2361 [2716] Even if Southeast Asian countries had the money, there might not be much drug left to buy, thanks to the historic chokehold bottleneck of RocheR17;s single plant production. A case in point is the United States. It didnR17;t matter how many billions President Bush wanted to spend on stockpiling Tamiflu; thereR17;s a waiting list for new orders and due to a delinquent delay in ordering its stockpile, the United States was towards the back of the line.2362 [2717] Roche wonR17;t disclose its production capacityR12;even to the World Health OrganizationR12;deeming it R20;commercially sensitiveR21; information.2363 [2718] The CEO told stockholders at an investorsR17; meeting, R20;WeR17;ve never actually released what our capacity is, nor do we intend to.R21;2364 [2719] This has resulted in negative comparisons to Bayer, the maker of anthrax treatment Cipro. The U.S. government scrambled to stockpile Cipro after the anthrax mailings that followed the September 11th terrorist attacks, but Bayer initially refused to enter into reimbursement negotiations or disclose its production capacity.2365 [2720] In response, the U.S. government told the German drug firm that if it did not ramp up production and sell Cipro at a reasonable cost, the United States would bypass its patent and start making the drug. Bayer gave in, slashed prices more than 50% and started boosting production.2366 [2721] Governments around the world are now similarly threatening Roche over its monopoly on Tamiflu. R20;ItR17;s almost bordering on the immoral to have just one drug company to produce a drug thatR17;s going to be a big part of the solution to avoiding the influenza pandemic,R21; said Philippine Health Secretary Francisco Duque.2367 [2722] A few U.S. lawmakers agree that the lives of potentially hundreds of millions of people should not depend on the efficiency and productivity of a single corporation. U.S. Representatives Dennis Kucinich and Marion Berry wrote Secretary Leavitt, R20;Compromising public health in order to preserve patent monopoly rights is inexcusable. We strongly urge you to immediately issue a compulsory license for TamifluR30;so that generic manufacturers can get to work shoring up our defense against avian flu.R21;2368 [2723] U.S. Senator Charles Schumer agrees. R20;Roche is putting their own interests ahead of world health,R21; Schumer said in a statement. R20;They should not be slow-walking this process when we have a potential pandemic that could occur at any time.R21;2369 [2724] The head of the nonprofit Consumer Project on Technology sums up such sentiment: R20;Public health should come first and the patent holderR17;s commercial interests should come second.R21;2370 [2725] R20;Something has to be done,R21; said the Emory University professor who created one of the two computer models showing that with enough Tamiflu quickly rushed to a burgeoning human outbreak, a pandemic could in theory be temporarily snuffed out at its source. R20;When you think of the potential damage a pandemic flu could do, and how little drug we have, the situation is quite absurd,R21; he said. R20;It makes sense to do something along the lines of what was done with AIDS drugs.R21;2371 [2726] With millions in sub-Saharan Africa in desperate need of lifesaving AIDS drugs unaffordably inflated at $12,000 per patient per year, former U.S. President Clinton brokered a deal in 2003 to allow generics to supply the developing world at near cost, less than $150 per patient.2372 [2727] RocheR12;French for R20;boulderR21;R12;refuses to yield on its monopoly. R20;Roche,R21; a company spokesperson said, R20;fully intends to remain the sole manufacturer of Tamiflu.R21;2373 [2728] Cipla, a Bombay-based leader in generic AIDS drug manufacture, claims to have perfected the process of manufacturing Tamiflu on its own. R20;My idea of a better-ordered world,R21; CiplaR17;s chairman told Forbes, R20;is one in which medical discoveries would be free of patents and there would be no profiteering from life or death.R21;2374 [2729] Thailand2375 [2730] and Taiwan also claim to have devised a method of mass production.2376 [2731] R20;We have tried our best to negotiate with Roche,R21; said the head of the clinical division of TaiwanR17;s National Health Research Institute. R20;[W]e appreciate their patent,R21; he said. R20;But to protect our people is the utmost important thing.R21;2377 [2732] RocheR17;s medical director for Tamiflu scoffed at the idea that such copycat manufacture would even be possible given the chemical complexity of their highly-secret production process.2378 [2733] Critics are skeptical. As one blogger commented, R20;IR17;ve never believed the R16;only Swiss gnomes can make itR17; story.R21;2379 [2734] Indeed, Cipla says it has already started production, intending to sell at R20;humanitarian prices.R21;2380 [2735] R20;I have always said,R21; the chairman told reporters, R20;there should be access to medicine at affordable prices.R21;2381 [2736] For violating corporate rights in an attempt to save millions of lives, Cipla and other generic manufacturers may face the wrath of RocheR17;s corporate lawyers if Roche chooses to fight them in court. An official Roche spokesperson declined to divulge whether they would do so, but said, R20;If we determine that there has been an infringement, weR17;d move to protect our rights and interests.R21;2382 [2737] RocheR17;s hesitation thus far may be a reflection of its experience trying to sue South Africa for selling generic AIDS drugs. In 1998, 39 pharmaceutical companies, including Roche,2383 [2738] sued the government of South AfricaR12;the country with the largest population of people living with HIV/AIDSR12;for circumventing patent protection of their profits.2384 [2739] The R20;patents versus patientsR21; debate became such a public relations nightmare that Roche and the other drug giants dropped their lawsuit three years later and paid South AfricaR17;s court costs.2385 [2740] Pharmaceutical companies argue that generic drugs undercut profits needed to spur new drug research and innovation. Industry spending on research and development, however, comes to only about half as much as is spent on marketing drugs2386 [2741] R12;sometimes even in the form of veritable kickbacks to doctors who prescribe them.2387 [2742] And most of the monopoly profits are spent on research used to create R20;me-tooR21; or R20;copycatR21; drugs to grab market share by mimicking profitable competing drugs.2388 [2743] Only a tiny percentage of new drugs offer R20;important potential contribution to existing therapies,R21; according to a study published in the Journal of the American Medical Association; the vast majority were rated by the FDA as having R20;little or no potential contribution.R21;2389 [2744] R20;Big PharmaR21; is the most profitable industry in the United States.2390 [2745] According to Harvard Medical SchoolR17;s Marcia Angell, the 10 pharmaceutical giants included in the Fortune 500 earned more profit than the other 490 corporations combined.2391 [2746] It spreads its influence with more than 3,000 paid lobbyists, leveraging lawmakers with more than $800 million directly spent to influence public policy since 1998.2392 [2747] After the United StatesR17; 2002 veto on Third World efforts to obtain cheaper generic pharmaceuticals, the editor of Lancet wrote, R20;Once again access to vital drugs to treat health emergencies among those living in poverty will be restricted solely to protect profit. And WHO has nothing to say on this issue.R21;2393 [2748] Similarly, when the Thai delegate at an executive board meeting of the World Health Organization proposed, in the spirit of the AIDS precedent, that poor countries at the front line of bird flu be allowed to override RocheR17;s patent to make affordable quantities of Tamiflu, the U.S. and French officials reportedly shut down the debate and effectively forced the meeting to adjourn without a vote.2394 [2749] Allegedly in return, Roche agreed to build a Tamiflu factory in the United States, but it may be years before the U.S. stockpile reaches adequate capacity.2395 [2750] In contrast, Kofi Annan, the Secretary-General of the United Nations, took a bold public stance in October 2005. R20;We should be clear in this situation,R21; he said. R20;We will take the measures to make sure poor and rich have access to the medications and the vaccines requiredR30;[by] making sure we do not allow intellectual property rights to get in the way of access of the poor to medication.R21;2396 [2751] Médecins Sans Frontičres (R20;Doctors Without BordersR21;), a leading proponent of cheaper generics, called AnnanR17;s comments a R20;very interesting political statement,R21; noting, R20;The UN has no legal power over patents, but national governments can set them aside, on a variety of grounds, including public health.R21;2397 [2752] Roche began to see the writing on the wall. Later that month, Roche announced that it would donate millions of courses of Tamiflu to the WHO.2398 [2753] Critics allege that this was done to appease the international community.2399 [2754] Quoting from an article about drug company tactics in the Journal of the American Medical Association, R20;No profit minded company would give gifts out of disinterested generosity.R21;2400 [2755] The move seems to have worked; the WHO has since been silent on the issue. The Director-General of the WHO explained: R20;When a company is doing its part, it is not a good incentive, encouragement [for the company] to do more.R21;2401 [2756] Roche also agreed to start licensing the drug to other manufacturers to relieve some of the production bottleneck. Many governments complain, however, that the license fees have been set too high,2402 [2757] and there is concern that this concession will still not come close to meeting the necessary massive global demand.2403 [2758] R20;So in a way,R21; social historian Mike Davis wrote, R20;the health of the whole world right now is held hostage to the corporate property rights of Roche.R21;2404 [2759] As a solution to the Tamiflu and vaccine shortages, Davis suggests that the federal government undertake the nonprofit development of lifeline medications, sidestepping Big Pharma.2405 [2760] The inventor of Tamiflu sister-drug Relenza claims that there are multiple formulas for new, inexpensive flu drugs gathering dust due to the historical lack of commercial interest. Preliminary testing shows one candidate potentially a hundred times more potent than drugs available today.2406 [2761] Bringing them to market, though, would be expected to take three to five years.2407 [2762] R20;[T]he repertoire of antiviral drugs,R21; the Institute of Medicine concluded, R20;is completely inadequate.R21;2408 [2763] (c) BirdFluBook.com | Home [2764] | Website by Lantern Media [2765] Bird Flu - End of the Line BirdFluBook.com [2766] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2767] End of the Line Two percent of the U.S. population covered Scientists have been urging countries to stockpile Tamiflu for years. R20;The answer seems to be: Stockpile these drugs now,R21; a 2001 review concluded, R20;in huge quantities.R21;2409 [2768] How huge? From a joint position statement of the Infectious Diseases Society of America and Society for Health care Epidemiology of America: R20;We advocate a national stockpile with minimum treatment courses for at least 25% or ideally 40% of the U.S. population.R21;2410 [2769] The National Vaccine Advisory Committee and the Advisory Committee on Immunization Practices are calling for 45% coverage. The strategy is to have a circulating stockpile to cover priority populations like health care workers and first responders, with a contingency plan for rapid additional synthesis for the remaining two-thirds or so of any national population.2411 [2770] The United States has neither priority coverage nor a contingency plan. Australia and New Zealand have national stockpiles for about 20% of their populations. The Australian Health Minister admits that this is glaringly insufficient.2412 [2771] New Zealand health care experts are calling for 100% coverage for every family in the country. R20;The costs of purchasing this drug cannot be compared,R21; one said, R20;with the costs that would occur if we have an outbreak of [pandemic] flu.R21;2413 [2772] France,2414 [2773] Great Britain,2415 [2774] and some other European nations are reportedly approaching coverage of 25% of the populace.2416 [2775] As of July, 2006, the United States has enough for 2% of Americans.2417 [2776] ,2418 [2777] The Bush administration ignored urgent warnings from the nationR17;s top scientists and waited too long to place their order. Given the global demand, the head of the pandemic task force at Roche explained, R20;The way we are approaching the discussions with governments is that we are operating on a first-come, first-serve basis.R21;2419 [2778] According to Roche there were 40 countries in line ahead of the United States.2420 [2779] The richest country in the world can spend all the billions it wants; but, as Irwin Redlener, the director of the National Center for Disaster Preparedness put it, R20;now that theyR17;re finally worked up about it, the store is closed.R21; R20;The U.S. is now in line,R21; he said, R20;behind much of the rest of the world.R21;2421 [2780] Experts around the world are shocked at AmericaR17;s delinquency. Royal London HospitalR17;s Professor John Oxford told ABC News, R20;The lack of advanced planning up until the moment in the United States, in the sense of not having a huge stockpile I think your citizens deserve, has surprised me and has dismayed me.R21;2422 [2781] Redlener concludes, R20;We are in a terribly unprepared condition right now.R21;2423 [2782] Or, as Webster put it, given our inadequate stockpile, R20;we wouldnR17;t have a hope in hell.R21;2424 [2783] At a Congressional hearing, Roche pointed out how inferior the U.S. stockpile was and listed off the countries further ahead in the queue. R20;Unfortunately,R21; RocheR17;s Tamiflu medical director testified, R20;givenR30;the increasing global demand, any government that does not stockpile sufficient quantities of Tamiflu in advance cannot be assured of an adequate supply at the outbreak of an influenza pandemic.R21;2425 [2784] The United States, essentially, was out of luck. Congress was not happy. Representative Michael Ferguson grilled the head of the CDC about the critical delay leaving the United States with but a few million treatment courses of Tamiflu. R20;IR17;m sure you will agree with me that that is a mere pittance,R21; Ferguson said. R20;ItR17;s nothing near what we will need to deal with a flu epidemic. WeR17;re staring down a loaded gun.R21;2426 [2785] Had the Bush administration placed its order just a few months before, sources close to the negotiators told the New York Times, Roche might have been able to deliver much of the U.S. supply as early as 2006. As it exists now, substantial quantities wonR17;t be coming in until 2007. Democrats complained that the delay put Americans in jeopardy. R20;The administration has just drug its feet through this whole process,R21; said Senator Tom Harkin.2427 [2786] Unfortunately, Democratic leadership on bird flu had also been lacking, heralding a plague on both their houses. R20;There have been many who foresaw this and urged the country to begin preparations sooner, and it would have been better if we had done so,R21; admitted BushR17;s Health and Human Services Secretary, Michael Leavitt.2428 [2787] R20;Do we wish we had ordered it sooner and more of it? I suspect one could say yes,R21;2429 [2788] When asked why the country didnR17;t place its order earlier, Leavitt replied, R20;I donR17;t know the answer to that.R21;2430 [2789] Secretary Leavitt said that negotiations with Roche for more Tamiflu are ongoing. R20;But itR17;s not a surrogate for preparation,R21; he told the New York Times. R20;ItR17;s like saying that if we could get everyone in America to wear seat belts, we would solve auto accidents. ItR17;s part of a comprehensive solution.R21;2431 [2790] There is a flaw in Mr. LeavittR17;s logic. Seatbelts and Tamiflu may both decrease mortality, but itR17;s not about getting people to use themR12;itR17;s providing them in the first place. Our current stockpile makes as much sense as installing seat belts in only 1% of cars though there may be as high as a 50% chance of dying unprotected in the coming crash. (c) BirdFluBook.com | Home [2791] | Website by Lantern Media [2792] Bird Flu - R20;The success or failure of any government in the final analysis must be measured by the well-being of its citizens. Nothing can be more important to a state than its public health.R21; BirdFluBook.com [2793] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2794] R20;The success or failure of any government in the final analysis must be measured by the well-being of its citizens. Nothing can be more important to a state than its public health.R21; R12;Franklin Delano Roosevelt2432 [2795] The R20;better late than neverR21; Bush proposal of billions to improve domestic antiviral and vaccine capacity is not without its critics. The head of the UN Food and Agriculture Organization questions why the United States isnR17;t helping more with efforts to monitor and control the disease in Southeast Asia. R20;It doesnR17;t look to us quite rational,R21; he said, R20;that we would be ready to spend so much money on the second line of defense and then on the first line of the combat field, weR17;re not putting even $100 million.R21;2433 [2796] Once it hits, paltry Tamiflu stockpiles in rich countries, as the Canadian Medical Association put it, provide no more than a pandemic R20;speed bump.R21;2434 [2797] But even if, on a global scale, antivirals do turn out just to be a R20;Band-Aid,R21; as the dean of Drexel UniversityR17;s School of Public Health noted, they would stop some of the bleeding.2435 [2798] Putting all our bird flu eggs in one Tamiflu basket may not be the wisest allocation of U.S. funds, though. A better solution may be to revitalize our critical public health infrastructure, which has been crippled, according to the National Academy of ScienceR17;s Institute of Medicine, by R20;grave underfunding and political neglect.R21;2436 [2799] As one senior senator admitted, R20;The decline in preparedness and effectiveness of the nationR17;s first-line medical defense systems can be traced to these ill advised budget cuts which forced the termination of essential research and training programs.R21;2437 [2800] Quoting from a 1988 Institute of Medicine report, R20;We have let down our public health guard as a nation and the health of the public is unnecessarily threatened as a result.R21;2438 [2801] A 2002 updated Institute report concluded that the U.S. public health system R20;that was in disarray in 1988 remains in disarray today.R21;2439 [2802] The General Director of the conservative Mercatus Center suggests a budget-neutral switch of most of the $10 billion currently going to developing anti-ballistic missile defense to in part help bolster local public health system preparedness.2440 [2803] Unfortunately, the opposite trend seems to be happening. Just as President Bush repeatedly underfunded the New Orleans levees,2441 [2804] funding for local and state public health departments continues to be cut. For fiscal 2005, the administration proposed a $100 million cut for state and local public health preparedness2442 [2805] and $129 million in proposed cuts for 2006.2443 [2806] House Democratic Leader Nancy Pelosi criticized these cuts as leaving R20;our state and local health agencies without the resources they need to protect communities in the event of a pandemic.R21;2444 [2807] The president of the National Association of County and City Health Officials agreed. R20;Critical funding is shrinking,R21; he said, R20;just as public health agencies are being required to expand their work in pandemic influenza preparation and response.R21;2445 [2808] After 9/11, the Department of Homeland Security spent billions preparing for disasters, but most of it understandably concentrated on acts of terrorism.2446 [2809] R20;No one cares about disasters until they happen,R21; laments one emergency management expert. R20;That is a political fact of life.R21;2447 [2810] The president of the Institute of Medicine and former dean of the Harvard School of Public Health describes nature as the worst terrorist one can imagine.2448 [2811] R20;ItR17;s too bad that Saddam HusseinR17;s not behind influenza,R21; complained a member of the federal governmentR17;s advisory panel on vaccination. R20;WeR17;d be doing a better job.R21;2449 [2812] (c) BirdFluBook.com | Home [2813] | Website by Lantern Media [2814] Bird Flu - Don't Need a Hurricane to Know Which Way the Wind Blows BirdFluBook.com [2815] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2816] Don't Need a Hurricane to Know Which Way the Wind Blows Katrina In the White House Rose Garden press conference that triggered a surge of bird flu media coverage, President Bush addressed the pandemic. R20;The people of the country ought to rest assured,R21; Bush said, R20;that weR17;re doing everything we can.R21;2450 [2817] Iowa Senator Tom Harkin was not assured. R20;R16;Trust usR17; is not something the administration can say after Katrina,R21; he said in an interview. R20;I donR17;t think Congress is in a mood to trust. We want plans. We want specific goals and procedures weR17;re going to take to prepare for this.R21;2451 [2818] Hurricane Katrina hit just days after Bush reportedly finished reading the classic historical text on the 1918 pandemic during his August vacation on his ranch. John M. BarryR17;s The Great Influenza: The Epic Story of the Deadliest Plague in History2452 [2819] details how the U.S. government, in the words of a 2005 Institute of Medicine report, R20;badly handledR21; the situation.2453 [2820] This combination may have spurred the administrationR17;s sudden interest. Redlener calls it the R20;post-Katrina effect.R21; He said, R20;I donR17;t think politically or perceptually the government feels that it could tolerate another tragically inadequate response to a major disaster.R21;2454 [2821] As Secretary Leavitt toured hurricane emergency shelters after Katrina and Rita, it hit him how catastrophic the pandemic would be. R20;What if it werenR17;t just New Orleans?R21; he recalls thinking. R20;What if it were Seattle, San Diego, Corpus Christi, Denver, Chicago, New York? Make your own list.R21;2455 [2822] R20;We have learned in the past weeks,R21; Secretary Leavitt told reporters, R20;that bad things can happen very fast.R21;2456 [2823] He also should have learned the folly of ignoring the warnings of experts. Whether it was the Challenger disaster, 9/11, or Katrina, there were experts who cautioned that these particular tragedies might happen. The U.S. Army Corps of Engineers had been warning about the levees for years. New OrleansR17; major newspaper ran a five-part series in 2002 accurately predicting not only the inevitable blow from a major storm, but the nightmarish aftermath.2457 [2824] R20;The danger of a major hurricane hitting New Orleans was ignored until it was too late,R21; said Senator Kennedy. R20;We canR17;t make the same mistake with pandemic flu.R21;2458 [2825] Though senior public health scientists describe an H5N1 pandemic with soundbites like R20;Hurricane Katrina a thousand times over,R21;2459 [2826] a former FEMA director in October 2005 described the level of federal preparation for the pandemic as R20;zero.R21;2460 [2827] In the pandemic, there will be no cavalry.2461 [2828] During Katrina. the nationR17;s resources were mobilized to aid three states. Imagine every city as New Orleans. Secretary Leavitt told state public health officials R20;We could be battling 5,000 different fronts at the same moment. Any community that fails to prepare with the expectation that the federal government will come to the rescue will be tragically wrong.R21;2462 [2829] In Chicago, public health officials have run through a mock influenza pandemic scenario. The simulation showed the public health system breaking down almost immediately.2463 [2830] The chief medical officer of the Department of Homeland Security warned, R20;The federal government will not be there to pick you off your roof in a pandemic.R21;2464 [2831] R20;If the avian flu were to hit here, it would be like having a Category 5 viral hurricane hit every single state simultaneously,R21; said the director of Trust for AmericaR17;s Health.2465 [2832] R20;WeR17;re not prepared. ItR17;s the ugly truth.R21;2466 [2833] George Mason UniversityR17;s Mercatus Center has concluded that we must R20;[r]ealize that the federal government will be largely powerless in the worst stages of a pandemic and make appropriate local plans.R21;2467 [2834] Each individual community is responsible for preparing its own pandemic plan; preparation begins with each family, each circle of friends, each neighborhood, each business, each township. To this end, a fledgling R20;experiment in collaborative problem solving in public healthR21; was launched called The Flu Wiki [2835] , available free for anyone to use at www.fluwikie.com [2836] , whose explicit purpose is to help local communities prepare for and cope with a pandemic outbreak. It is based on the R20;wikipediaR21; model of nonprofit, internet-based collaboration to share knowledge and ideas from around the world. Its success depends on the level and quality of public participation. Osterholm sees us living at a critical point in history. With time rapidly running out, we as a nation and a world need to act quickly and decisively. R20;Someday,R21; he wrote in the public policy journal Foreign Affairs, R20;after the next pandemic has come and gone, a commission much like the 9/11 Commission will be charged with determining how well government, business, and public health leaders prepared the world for the catastrophe when they had clear warning. What will be the verdict?R21;2468 [2837] According to the Holbert C. Harris Chair of Economics at George Mason University and General Director of the UniversityR17;s Mercatus Center, the administrationR17;s multibillion-dollar initiative to begin preparations may be too little too late. R20;[I]f a pandemic came in 2006,R21; he said, R20;American efforts would be statistically indistinguishable from zero preparation.R21;2469 [2838] The extra billions are R20;all well and good,R21; Osterholm agrees, R20;but people just donR17;t get it.R21; Osterholm explains, on behalf of the Center for Infectious Disease Research and Policy: If we were to begin a Manhattan ProjectR11;type response tonight to expand vaccine and drug production, we wouldnR17;t have a measurable impact on the availability of these critical products to sufficiently address a worldwide pandemic for at least several years. What we need to do right now is focus on what will get us through a pandemic without counting on drugs. We just donR17;t have a supply chain that can manufacture enough vaccine and antivirals to make a meaningful dent in what weR17;d need if the pandemic hits in the next two or three years. We need to think about things like food supplies, health care workers and facilities, essential services. WeR17;re wasting time.2470 [2839] (c) BirdFluBook.com | Home [2840] | Website by Lantern Media [2841] Bird Flu - The A List BirdFluBook.com [2842] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2843] The A List The United States has only enough Tamiflu stockpiled to cover about 2% of its population.2471 [2844] WhoR17;s going to get it? Given their mobility and multiple daily contacts, should vaccines and antivirals go to schoolchildren, college students, and workers in hopes of slowing the spread of the virus? Or should we target those at highest risk of death, like pregnant women or those with serious medical conditions?2472 [2845] The issue has been fiercely debated.2473 [2846] The World Health Organization recommends that priority be given to R20;essentialR21; personnel. But who is essential?2474 [2847] R20;When we had our meeting in Maine,R21; said the state epidemiologist, R20;we literally almost had fistfights break out between the medical community and those on the front line, such as firefighters and the sheriffs. Because who really is considered critical?R21;2475 [2848] How about utility workers who maintain the electricity, water, and heat supply? Should we provide for the doctor but not the nurse? Health care workers may not go to work unless we cover their families as well, for fear of bringing work home with them in the form of a deadly infection. As one financial analystR17;s report commented, R20;One can only imagine the furor and upset caused by giving potentially lifesaving medication to only one member of a family.R21;2476 [2849] Antiviral rationing raises not only ethical and legal questions, but distribution and security issues as well. Black markets, theft, and fraud are considered probable.2477 [2850] Riots are imagined at the distribution centers.2478 [2851] R20;Historically, whenever thereR17;s a crisis,R21; a medical historian notes, R20;youR17;ll find stockpiling, hoarding, black marketeering and generally bad behavior. ItR17;s been going on since Hippocrates.R21;2479 [2852] Earning public trust by communicating clear, transparent guidelines now should lessen the chances of panic later, and help with the most effective distribution of these scarce resources.2480 [2853] R20;So weR17;re going to have very little stuff and itR17;s already stuck away in stockpiles that people will protect with their lives,R21; UN bird flu czar David Nabarro points out. R20;And yet weR17;re going to have to find some way to ration these things so that they are given to the folk who need them the most.R21;2481 [2854] Countries have formulated different priority lists. While Australia embraces funeral directors among those first in line,2482 [2855] Canada places key R20;decision-makersR21; such as R20;elected officialsR21; at the top the list.2483 [2856] Britain also includes prominent politicians and adds workers at the BBC over pregnant women, children, and sick patients.2484 [2857] The mayor of London has stockpiled more than Ł1 million worth of Tamiflu for his personal office and staffR12;nearly 100,000 tablets.2485 [2858] The United States also intends to prioritize R20;key government officials.R21;2486 [2859] R20;ThatR17;s a different mind-set than people are used to,R21; explained NebraskaR17;s chief medical officer, R20;and itR17;s going to be a little bit controversial.R21;2487 [2860] In 2004, the Vietnamese army was criticized for confiscating all the foreign donations of Tamiflu, even refusing to share with veterinarians working with infected flocks.2488 [2861] The military commandeering of national supplies may not, however, be exceptional. The Pentagon has long claimed first dibs on the U.S. Tamiflu stockpile, insisting that R20;top priority for use of vaccine or antiviral medications is in forward deployed operational forces.R21;2489 [2862] Given President BushR17;s suggested militarization of the pandemic response, imagine the conflict this could create between troops in the streets and critical first-responder medical personnel, fighting over the limited supply and further threatening the public health response.2490 [2863] At this point, there will be none left over for the general U.S. population.2491 [2864] Do the math: Excluding military appropriation, there are nearly ten million health care workers and more than two million public safety workers such as police and firefighters, more than twice the mid-2006 stockpile.2492 [2865] Even among countries with the highest per-capita stockpiles in the world, like Australia, only 10% of the national stockpile is expected to reach the general population.2493 [2866] (c) BirdFluBook.com | Home [2867] | Website by Lantern Media [2868] Bird Flu - Stretching the Stockpile BirdFluBook.com [2869] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2870] Stretching the Stockpile Scientists are understandably scrambling to find ways of stretching national stockpiles. During World War II, scientists discovered how to extend precious penicillin supplies by co-administering a drug called probenicid that acts upon the kidney to inhibit the secretion of drugs like penicillin. By slowing the bodyR17;s ability to rid itself of the penicillin through the urine, smaller doses of the antibiotic could be given less frequently, preserving the valuable drug for others. Roche discovered that the same was true for Tamiflu in 2002.2494 [2871] Roche found that probenicid doubled the time that Tamiflu spent circulating in the human bloodstream, effectively halving the dose necessary to treat someone with the flu. Since probenicid is relatively safe, cheap, and plentiful, joint administration could double the number of people treated by current global Tamiflu stores. R20;This is wonderful,R21; exclaimed David Fedson, former medical director of French vaccine giant Aventis Pasteur. R20;It is extremely important for global public health because it implies that the stockpiles now being ordered by more than 40 countries could be extended, perhaps in dramatic fashion.R21;2495 [2872] Roche has known this for years; have they considered the option? R20;It doesnR17;t seem so,R21; said a Roche spokesperson. R20;It is an interesting idea,R21; she added, R20;but we canR17;t really say anything.R21;2496 [2873] When the science journal Nature asked the WHO and the FDA about the idea, they also declined to comment. Fedson, like many scientists, finds the apparent lack of attention given to this option R20;stupefying.R21;2497 [2874] The probenicid option would seem the more appetizing choice compared to the creative (though erroneous) solution developed by internist Grattan Woodson, M.D. Tamiflu is normally given as a ten-pill course, two pills a day for five days. If a family of five is privileged enough to have a single pack of ten pills, how could one possibly make such a SophieR17;s Choice? Enter WoodsonR17;s R20;Tamiflu Re-Administration Strategy.R21; Assuming that Tamiflu was excreted unchanged by the kidneys, he figured that if each family member were to take two pills and then drink his or her own urine for five days, the entire family could, in theory, be saved. Do try this at home, said Woodson, but only under medical supervision to ensure proper hydration. Woodson listed in his book ways to improve palatabilityR12;chilled, preferably, and flavored with citrus.2498 [2875] Unfortunately (or perhaps fortunately) this strategy wonR17;t work. Tamiflu is altered by the liver such that urinated Tamiflu would not be readily re-absorbed by the intestine. (c) BirdFluBook.com | Home [2876] | Website by Lantern Media [2877] Bird Flu - Get It Now While Supplies Last BirdFluBook.com [2878] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2879] Get It Now While Supplies Last Big business is not waiting for the government to get its act together. Multinational corporations have been stockpiling what Fortune described as R20;now the most sought-after drug in the world.R21;2499 [2880] Corporations from Microsoft to Shell2500 [2881] to General Electric have been advised to stock up on the dwindling global supplies of antivirals.2501 [2882] Virgin Atlantic chair Richard Branson snapped up 100,000 pills of Tamiflu for his employees.2502 [2883] One commentator poked fun at leaked corporate continuity plans, which have tended to concentrate on maintaining profitability through the pandemic. A column in the London Observer, titled, R20;Bird Flu: YouR17;ll Die, but Your I.T. Will Survive,R21; spoofed lines like R20;Assess your business continuity preparedness for this type of workforce outage scenario and try to improve it (if necessary),R21; by adding suggestions such as R20;Bulk buy flowers and coffins as part of your business continuity preparedness for a permanent workforce outage scenario.R21; And R20;Set up email autoresponders to communicate: R16;Sorry, IR17;m out of the office due to death.R17;R21;2503 [2884] UN flu czar David Nabarro testified before a U.K. House of Lords inquiry into pandemic flu. He finds the pandemic plans of the large multinational companies R20;very, very scaryR21; and is concerned that their R20;lockdownR21; attitude will interfere with potential coordination efforts. R20;They are closing down, retrenching, lockdown of personnel, staying in their homes, one or two monthsR17; survival rations, their own Tamiflu stocks in some cases and other medications. That kind of reaction will make the necessary joined-up early response work very, very difficult.R21;2504 [2885] No law bars corporate hoarding of scarce lifeline medications in the United States.2505 [2886] The practice was apparently so pervasive among U.S. corporations that Roche decided to temporarily2506 [2887] suspend all shipments to private sector recipients in the United States.2507 [2888] Similar moves to stem corporate accumulations have been made within other countries.2508 [2889] Many doctors have also been quietly siphoning personal Tamiflu stockpiles for their friends and families.2509 [2890] It seems that unless we want to beg our politicians, doctors, or CEOs for a dip in their respective urinals, Joe Blow and Jane Q. Public are going to be left hanging out to dry without any medical protection. Should we all be buying a private stash? Nobel Prize winner Peter Doherty says yes, everyone should consider asking their doctors for prescriptions for Tamiflu to be filled and stored for safe keeping. Professor Doherty never leaves home without his pack of TamifluR12;what he calls his $56 R20;insurance policy.R21;2510 [2891] Others agree. Graeme Laver, the molecular biologist whose discoveries led to the invention of the antiviral drugs, said: R20;They should be available for people to get quickly. Imagine if one of your children develops fever and aches and pains, and you know the bird flu is around. You will want that drug now. But if it is all locked upR30;.R21;2511 [2892] Laver has his own supply.2512 [2893] LaverR17;s colleague, the director of the WHO collaborating center on influenza in Australia, has a supply for his family. R20;Most people I know in the field have their own supply,R21; he said. R20;People need to give some thought to whether they want to take some responsibility for their own protection.R21;2513 [2894] A World Health Organization spokesperson was criticized for R20;risking panicR21; by recommending that everyone try to get Tamiflu for their families if they can. R20;We do recommend that in the average household you do have Tamiflu if you can afford it,R21; he said on Hong KongR17;s public radio station, R20;and if you can find it in the present circumstances.R21;2514 [2895] In light of the drugR17;s scarcity, the president of the Hong Kong Medical Association thought it better that people didnR17;t know. R20;In view of the shortage of Tamiflu on the market, this particular expression may stir up people to go out and stockpile Tamiflu,R21; he said. R20;This will create even more stress.R21; The American Medical Association opposes having a personal reserve of Tamiflu for two reasons. Although the AMA R20;understands the concern people have for their health and the health of their families,R21; it recommends against having a pack of Tamiflu R20;just in caseR21; because people may accidentally initiate treatment for an unrelated illness, contending that R20;[n]eedlessly taking an antiviral may contribute to the problem of resistance to that antiviral drug, which would then make the drug less useful in the event of an actual avian flu outbreak.R21; The AMA also argues that the Tamiflu is needed now to treat seasonal cases of the regular flu, which can be dangerous in high-risk and elderly individuals.2515 [2896] Antiviral resistance is different from antibacterial resistance. The reason the medical professionR17;s overprescription of antibiotics is a bad idea is that when you take an antibiotic for a typical cough or cold, not only is it ineffective (because upper respiratory tract infections are overwhelmingly caused by viruses, not bacteria),2516 [2897] but you can generate antibiotic resistance among unrelated bacteria you harbor in your body. The nostrils of between 25% and 30% of us are colonized, for example, by a bacteria called Staphylococcus aureas. In our noses, the bacteria does no harm; but if it gets into an open wound, R20;staphR21; bacteria can cause a serious infection.2517 [2898] Taking unnecessary antibiotics could turn this harmless nasal traveler into a R20;flesh-eatingR21; superbug by selecting for antibiotic resistance.2518 [2899] Further, the bug could swap genes with other bacteria and spread the antibiotic resistance around.2519 [2900] Influenza viral drug resistance, however, cannot be generated in the same way. People do not chronically harbor influenza virus. If, as the AMA fears, some people accidentally take their Tamiflu for the wrong illness, then it may be wasted, but itR17;s not possible to promote resistance because, by definition, they do not have the flu. In other words, there is no flu virus for the drug to affect. If, on the other hand, they took it correctlyR12;when they started showing symptoms of a deadly pandemic virusR12;they might significantly improve their chances of survival, exactly what the personal stash was designed to do. The AMA evidently wants to conserve the remaining U.S. supply of Tamiflu for the elderly and other high-risk individuals during the regular flu season. However, because itR17;s so difficult to accurately diagnose the flu outside of a known epidemic, a 2006 systematic review published in the Lancet concluded that Tamiflu R20;should not be used in seasonal influenza control and should only be used in a serious epidemic or pandemicR30;.R21;2520 [2901] Additionally, the seasonal flu is so mild that even in high-risk populations the mortality rates of seasonal influenzaR12;even untreatedR12;is about 0.1%.2521 [2902] H5N1 currently kills about 50% of those affected.2522 [2903] ,2523 [2904] During this precarious time when Tamiflu is so scarce, might it not make more sense to safeguard the drug for the inevitable pandemic rather than use it against the regular fluR12;the opposite of the AMAR17;s recommendations?3171 [2905] Unfortunately, the AMA canR17;t have it both ways. At least, perhaps, the AMA should stop criticizing those with the foresight to obtain the drug to protect their families. U.S. Health Secretary Leavitt was asked if he personally had any Tamiflu at home in his medicine cabinet. He replied, R20;I have a blister pack of 10 with me.R21;2524 [2906] Some bioethicists are concerned about affordability.2525 [2907] It isnR17;t fair that only those who can cough up $50 to $100 in advance be allowed access to the drug, but do they really imagine poor people getting any once the pandemic strikes? Asked if he was concerned that only people who could afford the drug were likely to have their own supply, the president of the Royal New Zealand College of General Practitioners replied, R20;IR17;m afraid thatR17;s how life works.R21;2526 [2908] As a public health practitioner and associate director within the Department of Homeland Security, Osterholm thinks itR17;s best to leave it up to the government to decide how to distribute the existing national stores.2527 [2909] After witnessing the bureaucratic bungling during Katrina, others are skeptical that the pills would be dispensed efficiently and equitably during a true national pandemic emergency. Might it not be better to get it into peopleR17;s hands now for safekeeping? Although Osterholm retains faith in the system, R20;[A]s a husband, a father and a friend,R21; Osterholm said, R20;do I think the idea of personally stockpiling is something you should be considering? Absolutely.R21;2528 [2910] Right or wrong, people are buying it up. Before Roche suspended shipments to North America in October 2005, it disclosed that more Tamiflu was being sold in a single day in Canada than was sold in all of 2004. In the United States, prescriptions were up more than 700%.2529 [2911] R20;Sales,R21; remarked one internet pharmacy spokesperson, R20;are definitely off the chart.R21;2530 [2912] If the early events in EuropeR17;s experience with outbreaks among birds are any indication, the scant U.S. supply will dwindle even further. R20;Following four ducks in Romania carrying avian flu, Europe has gone mad,R21; the head of pharmaceuticals at Roche said. R20;I donR17;t think it is possible to find a single packet of Tamiflu in Paris anymore.R21;2531 [2913] After TurkeyR17;s infected turkeys were announced, Belgrade sold out in a day.2532 [2914] The Turkish people snatched up their countryR17;s one million pills within two weeks.2533 [2915] In the United States, scattered stocks of Tamiflu remain strewn among pharmacies across the country. After obtaining the necessary prescription from oneR17;s doctor, those interested in stocking up may have to run through the yellow pages, calling around to pharmacies in order to find any Tamiflu locally. Internet pharmacies are another option, but may carry higher risk of counterfeit product.2534 [2916] U.S. customs agents have already intercepted shipments of counterfeit Tamiflu.2535 [2917] Even during the regular flu season, criminal cases of phony flu vaccines have emerged.2536 [2918] To reduce the risk of ordering fraudulent, misbranded, or adulterated drugs, one can stick to websites accredited by the (link)National Association of Boards of Pharmacy at (link) www.nabp.net/vipps/consumer/listall.asp, the (link)Internet and Mailorder Pharmacy Accreditation Commission at (link), or the (link)Canadian International Pharmacy Association, (link)www.ciparx.ca/cipa_pharmacies.html. Roche marks boxes with a three-2537 [2919] to five-year2538 [2920] expiration date, but the drug is expected to last at least ten years without losing its activity if kept under proper conditions.2539 [2921] The drug should be stored at room temperature away from humidityR12;not in the medicine cabinet in a bathroom that can get steamy, under the kitchen sink, or in the refrigerator. Stuffing it in a sock drawer is fine, but the WHO cautions that R20;because antivirals will become valuable commodities during a pandemic, they should be stored in a secure place.R21;2540 [2922] Since Chinese poultry farmers may have rendered the entire amantadine class of antiviral drugs useless, Relenza is the only other option if Tamiflu is unavailable. Relenza was invented in the 1980s and remains the only other licensed drug within the chemical class of Tamiflu.2541 [2923] Relenza lacks oral bioavailability, though, meaning that it has to be directly inhaled into the lungs of flu patients with a special powder inhaler device. When the Tamiflu pill was invented in 1996, Relenza use declined, but itR17;s making a comeback, thanks to the Tamiflu shortage.2542 [2924] Governments favor Tamiflu.2543 [2925] The mode of inhaled delivery not only makes Relenza more difficult to self-administer, but may also preclude use by small children (who may not be able to follow a caregiverR17;s instruction) and those with asthma (because of potential respiratory side effects).2544 [2926] RelenzaR17;s greatest drawback, though, may be its lack of systemic circulation. Although Tamiflu and Relenza are considered similarly potent against the virus,2545 [2927] very little of the inhaled Relenza is absorbed into the bloodstream from the lungs. This quality may make it safer for pregnant women to use,2546 [2928] but it may also make it a poor choice against viruses like H5N1. RelenzaR17;s localized application may be fine for the seasonal flu or for milder pandemics in which the virus concentrates within the lungs, but H5N1 could hide from Relenza, storming its way through other organ systems of the body.2547 [2929] Relenza proponents do point out one important potential advantage to the drug: the seeming decreased likelihoodR12;compared to TamifluR12;of generating viral resistance.2548 [2930] H5N1 is a R20;real fast learner,R21;2549 [2931] as one British expert pointed out, and already a few, rare, partially Tamiflu-resistant H5N1 strains have been identified.2550 [2932] If a pandemic strain were to emerge Tamiflu-resistant, Relenza would at least provide some protection. But, according to a spokesperson for GlaxoSmithKline, the drug giant that makes Relenza, the entire companyR17;s supply for 2005 and 2006 has already been committed to health authorities. R20;This is not something you can just turn on the faucet and something comes out,R21; he said.2551 [2933] Tamiflu needs to be taken properly to diminish the risk of promoting resistance. Just as itR17;s important to complete a full course of antibacterial antibiotics, even after one starts to feel better, itR17;s important to complete at least the full five days of Tamiflu treatment. This would argue against making Tamiflu available over the counter, as Roche2552 [2934] and others2553 [2935] have advocated. Keeping it a prescription-only drug allows the doctors to impress upon their patients the need to take the full course. Another option would be to allow pharmacists to dispense it without prescription, but with proper guidance, ideally in conjunction with a rapid diagnostic flu test.2554 [2936] Flooding countries with cheap generic Tamiflu without clear instruction does raise a legitimate risk of fostering global resistance.2555 [2937] R20;Be careful of what you wish for,R21; warned one expert.2556 [2938] A more serious scenario is if the global poultry industry finds generic Tamiflu cost-effective enough to start feeding it to their chickens. Assuring that a generic version of Tamiflu is not and will not be used on poultry is R20;going to be very hard,R21; according to Osterholm. R20;ThereR17;s no evidence it is being used in China right now,R21; he said, R20;but we could have said the same six months ago [about amantadine].R21;2557 [2939] (c) BirdFluBook.com | Home [2940] | Website by Lantern Media [2941] Bird Flu - Crash Course BirdFluBook.com [2942] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2943] Crash Course Neuraminidase crystals Timing is critical. For the regular flu, initiation of treatment for the antiviralsR12;whether the first swallowed capsule of Tamiflu or the first inhaled breath of RelenzaR12;needs to happen within 36 or 48 hours of initial symptoms, such as a spiking fever, chills, cough, and body aches. The cytokine storm associated with H5N1 is so fast and furious, though, that experts advise initiating treatment as soon as possible, ideally within hours of onset.2558 [2944] Unlike antibiotics that can kill a bacterial invader, these antivirals donR17;t kill the virus, they just slow it down. If the hemagglutinin (H) surface spike can be thought of as the key the virus uses to get into our cells, the neuraminidase (N) spike can be thought of as the virusR17;s key to get out. The H spike binds onto sialic acid receptors on the surfaces of our cells to gain entry and take over. The subsequent thousands of progeny viruses budding from the infected cell have a problem, though. As they bubble out of the cells, wrapping themselves in our cellsR17; own membrane, the exiting virus is snared on the dying cellsR17; remaining Velcro-like loops of sialic acid. The sticky ability of the H spikes to attach and infect new cells is the same property that keeps it anchored to the cell in which it was born. The virus solves this problem with its neuraminidase enzyme spike that lets it shave itself off from the cellR17;s sialic (also known as neuraminic) acid attachments, cutting the loops that bind it. The N spike that allows the virus to plow through our lungR17;s protective mucus is the same spike that can dissolve the chemical umbilical cord that keeps it bound to its cell of origin.2559 [2945] One of the ways our bodies deal with influenza is with targeted attacks against the virus, making antibodies that hone in on the N spikes and cripple their function. In this way, our immune system can limit the spread of the virus by preventing its release from infected cells. Under an electron microscope, scientists can visualize the antibodies in action, clumping all the budding viruses to the cell surface and preventing their escape. The problem is that it takes time to generate these antibodies, especially if the body has never seen the particular virus before. Scientists figured that if they could make a drug that mimics the bodyR17;s own strategy, a drug that plugs up the neuraminidase enzyme as effectively as the antibodies, they could stop the virus in its tracks. To design R20;plug drugs,R21;2560 [2946] researchers first need to solve the three-dimensional structure of the enzyme to construct a molecule that can cork it up. Scientists can use X-ray crystallography to visualize the structure of proteins, but first they have to make a neuraminidase crystal. In one of the great epic stories of drug discovery, neuraminidase spikes from a virus swabbed from the feathered backside of a White-Capped Noddy Tern caught off AustraliaR17;s Great Barrier Reef were sent into outer space to crystallize in the weightless microgravity of the Soviet space station Mir.2561 [2947] Other scientists scoffed at the notion that this team had actually succeeded in producing crystals from such a fastidious protein. R20;All youR17;ve got are salt crystalsR12;donR17;t be such an idiot,R21; the scientists who made the breakthrough remember hearing.2562 [2948] With the exact structure of the neuraminidase known, it was then possible to design neuraminidase inhibitors Relenza, and, subsequently, Tamiflu, to sheath the tips of the viral N spikes and prevent them from cutting the maternal ties that bind it.2563 [2949] This is why the drug has to be taken as soon as possible following infection. These antivirals donR17;t kill the virus; they just slow the spread, potentially giving the body the critical head start it needs to clear the virus before it can cause too much damage or, in the case of bird flu viruses like H5N1, trigger a cytokine storm. Taken too late, one of the investigators involved in the drugsR17; discovery explains, R20;you may be able to stop the virus, but the immune response would likely kill you.R21;2564 [2950] Taken within 28 hours after experimental inoculation with flu virus, these drugs can, within a single day, effect a 100-fold reduction in the viral loadR12;the number of viral mutants the original virus is able to spin off.2565 [2951] In a laboratory setting, every flu virus with pandemic potential so far tested is susceptible to this class of drugs,2566 [2952] including the genetically engineered 1918 resurrection2567 [2953] and H5N1. Clinical data on H5N1 are sparse since most of the human H5N1 infections have occurred in areas that lacked ready access to any antivirals. Tamiflu has also been successfully used on a long-term basis to prevent infection,2568 [2954] but given the drugR17;s scarcity, this has been considered wasteful of our limited global supply and may foster viral resistance.2569 [2955] The way the virus tries to outsmart the antiviral drugs is to weaken the binding power of its hemagglutinin spike so that it does not get as bound up trying to make its exit. If it canR17;t beat them, it tries to join them by attempting to rid itself of the need for the N spike altogether. The consequence for the virus, though, is reduced binding capacity, compromising its ability to infect new cells.2570 [2956] Even if the drug no longer works, the resulting resistant virus may be less of a threat, having hobbled itself to undermine the drug. R20;The indications from the lab data are that the virus is sort of a wimpier virus when itR17;s resistant to the drug,R21; says Earl Brown, a prominent influenza virologist at the University of Ottawa. R20;So if thatR17;s always the case, thatR17;s good. But I think given limited experience with the drug, you canR17;t be too categorical at this point.R21;2571 [2957] Having a supply of both Tamiflu and Relenza might be a prudent strategy. Late treatment is ineffectiveR12;the virus has already gotten out of hand.2572 [2958] This is another reason why personal stockpiles have been considered by some to be so vital. Ideally, a personal supply wouldnR17;t be necessary, but studies show that only a fraction of patients are able to get to their doctors within 48 hours of initial flu symptoms, and thatR17;s during regular flu season, not a crisis situation where medical facilities will be quickly overwhelmed.2573 [2959] With the Katrina debacle in mind, one worries whether the national U.S. stockpile will be efficiently distributed in time. R20;Let us say the pandemic came first to California,R21; one analyst asked. R20;Would supplies in Kansas be shipped out west? Would they ever come back? In any case we can expect time-consuming fights.R21;2574 [2960] After just a few days of infection, flu victims tend to have already started killing off the virusR12;or, the virus has already started killing off them. The standard adult treatment course for Tamiflu is one capsule taken twice a day for five days, once in the morning and once in the evening without missing a single dose. Tamiflu tends to be well tolerated with minimal side effects (most often mild to moderate nausea in approximately one in ten people who take it).2575 [2961] Relenza is inhaled using the Rotadisk(R) inhaler device and instructions that come with each prescriptionR12;typically two inhalations twice a day for five days. In rare cases, Relenza may trigger asthma-like attacks and is therefore not recommended for people with underlying bronchial disease. Recent data from experiments on mice suggest that the customary five-day course of treatment may not be sufficient, however. WebsterR17;s group at St. JudeR17;s Hospital infected 20 mice with H5N1, which killed all of them in short order. The researchers took another 20 mice and put half on human-equivalent doses of Tamiflu for five days and the other half on Tamiflu for eight days. On the standard human-dosing regimen of five days, only half survived. Evidently the Tamiflu slowed H5N1 enough for the animalsR17; immune systems to beat back the virus, but once the drug was stopped at day five, the remaining virus resurged with a vengeance to kill off half of the survivors. Extending the treatment for three additional days allowed eight out of ten of the mice to successfully defeat the virus and survive.2576 [2962] While normally R20;unwise to extrapolate information concerning drugs from one species to another,R21;2577 [2963] lacking adequate human data, this experiment suggests that it may be prudent to take Tamiflu for longer than the usual five-day course due to the exceptional ferocity of this virus. The experiment also suggests that even if one were to start oneR17;s Tamiflu course early and extend it with probenicid or additional packs of pills, there remains a significant risk of dying. And the experiment was done under idealized conditions. The animals were started on Tamiflu not just early, but really earlyR12;hours before they were even infected. Given that under controlled laboratory conditions a significant percentage of the animals diedR12;even after a prolonged eight-day courseR12;the best course of action is not to get infected in the first place. (c) BirdFluBook.com | Home [2964] | Website by Lantern Media [2965] Bird Flu - Coming Soon to a Theater Near You BirdFluBook.com [2966] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [2967] Coming Soon to a Theater Near You One authority was quoted as saying, R20;Short of obtaining [antiviral] drugs, thereR17;s not really much we can do to prepare.R21;2578 [2968] ThatR17;s hardly true. While only the R20;happy fewR21; might have access to Tamiflu or an emerging vaccine, the unhappy many can still practice defensive strategies such as social distancing, respiratory etiquette, and other hygiene measures like hand sanitization. Even if Tamiflu reduced the risk of dying by 80%, given the present lethality of H5N1, these would seem prudent practices for everyone. No one just comes down with the flu. You catch the virus from someone else or, more precisely, someone elseR17;s virus catches you. In 1918, half of the worldR17;s population became infected by the virus. Although not all who were infected fell ill, half of the worldR17;s inhabitants were exposed. The half-empty interpretation is of an unthinkably transmissible contagionR12;half the world infected! The half-full view, though, recognizes that fully half of the global populace was able to hide from the virus. The question then becomes, how does this other half live? How can you better the odds that youR17;ll fall into the lucky half? Social distancing has been described as avoiding any R20;unnecessary contact of people.R21;2579 [2969] Influenza is a communicable disease spread from one person to the next; the fewer people you come in contact with, the fewer chances you have of catching it. On a personal level, this means staying in oneR17;s home, not going to work, and avoiding crowds like the plague, especially in enclosed spaces. On a community basis, this may mean closing schools, churches, and other public gatherings.2580 [2970] R20;Most Americans take for granted their freedom,R21; reads one legal review of the hygiene laws that were imposed in 1918, R20;to associate with others in a variety of social settings.R21;2581 [2971] At the recommendation of the Surgeon General of the U.S. Public Health Service in 1918,2582 [2972] entire states reportedly shut down public gatherings of any kind, including funerals.2583 [2973] The American Public Health Association agreed that R20;[n]onessential gatherings should be prohibited.R21; R20;There should be laws,R21; wrote the APHA, for example, in its official report, R20;against the use of common cups.R21; Laws R20;regulating coughing and sneezingR21; were also deemed desirable.2584 [2974] Huge signs in New York streets warned: R20;It is unlawful to cough and sneeze.R21; Violators faced up to a year in jail.2585 [2975] Within days, more than 500 New Yorkers were hauled into court. ChicagoR17;s Health Commissioner told the police department, R20;Arrest thousands, if necessary, to stop sneezing in public.R21;2586 [2976] Signs read, R20;Spit Spreads Death.R21;2587 [2977] Across America, there were cities of masked faces. People were afraid to talk to one another, eat with one another, kiss one another. The country held its breath.2588 [2978] Some cities made it a crime to shake hands.2589 [2979] Hundreds were rounded up for not wearing masks and thrown in jail for up to 30 days.2590 [2980] Civil libertarians and Christian Scientists, with support from some business sectors, formed the Anti-Mask League in protest. Tobacconists complained that sales were down because people couldnR17;t smoke with their masks on. Shop owners worried that compulsory masks would discourage people from Christmas shopping.2591 [2981] Due to business pressure, some cities closed down all schools, churches, and theaters, but kept the department stores open,2592 [2982] giving a whole new meaning, perhaps, to the phrase R20;shop R17;til you drop.R21; The closing of schools and other public institutions was not universally accepted.2593 [2983] A 1918 editorial in the British Medical Journal read, R20;[E]very town-dweller who is susceptible must sooner or later contract influenza whatever the public health authorities may do; and that the more schools and public meetings are banned and the general life of the community dislocated the greater will be the unemployment and depression.R21;2594 [2984] The closing of schools, however, may have been especially useful in stemming the spread.2595 [2985] According to the World Health Organization, children are the primary vectors for the spread of pandemic influenza.2596 [2986] Evidence from a variety of sources mark kids as the major transmitters of influenza in general in a given community.2597 [2987] A real-time surveillance system set up at BostonR17;s ChildrenR17;s Hospital found that school-aged children may actually drive each winterR17;s flu epidemic. Preschoolers in particular are considered R20;hotbeds of infection.R21;2598 [2988] Children are able to shed flu virus for up to six days prior to showing any symptoms and, as the CDC delicately puts it, they are also R20;not skilled at handling their secretions.R21;3185 [2989] So for almost a week before anyone suspects they are infected, they can be spreading the virus to others.2599 [2990] In this way, children play a central role in disseminating influenza. Studies suggest that they pick up the virus mixing with other kids at school and then become the major entry point for the virus to gain access to the household.2600 [2991] Japan experimented with its flu vaccine strategy in the 1970s and 1980s and showed that by targeting children for flu shots, hospitalization and death in the elderly could be reduced. Each flu season, children kill their grandparents.2601 [2992] ItR17;s easier for some to stay away from crowds and kids than others, but avoiding influenza is a difficult task for all.2602 [2993] Exhaled into the air and surviving for hours on solid surfaces like metal or plastic, influenza is notoriously transmissible.2603 [2994] After the 1968 pandemic, one scholar wrote, R20;Those who have spent their lives in attempts to further the conquest of infectious disease are humiliated by the contrast between the success of the astronauts and the failure to control acute respiratory disease.R21;2604 [2995] Another expert noted at a conference on pandemic influenza, R20;I know how to avoid getting AIDS, but I do not know how to avoid getting influenza.R21;2605 [2996] To avoid the disease completely would mean a divorce from society. A realistically stark description of the coming pandemic at a Council on Foreign Relations forum convinced one audience member R20;to get in my car and move to Montana or something.R21; He was told, R20;It wonR17;t help.R21;2606 [2997] Webster told the New Yorker: R20;We have to prepare as if weR17;re going to war and the public needs to understand that clearlyR30;if this does happen, and I fully expect it will, there will be no place for any of us to hide. Not in the United States or in Europe or in a bunker somewhere. The virus is a very promiscuous and efficient killer.R21;2607 [2998] In 1918, it took only one stranger to bring death to an entire community, even in the farthest-flung parts of the world. In ChinaR17;s remote Shanxi province, the spread of the pandemic was traced to a single woodcutter, tramping from village to village. In Canada, the virus wore the uniform of a stubborn Canadian Pacific Railways official who flouted quarantine, dropping off infected repatriate soldiers from Quebec all the way west to Vancouver. An entire port city in Nigeria was infected by fewer than ten persons.2608 [2999] Social distancing, taken to its logical extreme, would mean total isolation from the outside world. True, becoming a hermit living in a cave would presumably preclude one from dying during the pandemic, but this is easier said than done. No man is an islandR30;but what if he lived on one? Pandemic influenza first reached the Pacific Islands in 1830 on the Messenger of Hope, a ship carrying the first load of Christian missionaries. Fast forward to November 7, 1918. The SS Taline pulls into Apia Harbor in the New Zealand colonial island of Western Samoa from Auckland at 9:35 a.m. Despite many Spanish influenza-infested passengers aboard, the captain tells the island medical officer that no one is sick. With a clean bill of health, the yellow flag of quarantine is lowered, and the ship is docked.2609 [3000] Just miles away lay American Samoa, an island governed by the U.S. Navy. Word spread of the outbreak on Western Samoa. The American Commander offered to send volunteer medical personnel to help. Western SamoaR17;s administrator stubbornly refused, disconnecting the telegraph and later explaining that he R20;didnR17;t like Americans.R21;2610 [3001] A week later, the New Zealand army lieutenant colonel in charge of Western Samoa ordered all communications between the islands cut, furious over American SamoaR17;s refusal to let any ships come near its island.2611 [3002] The U.S. Naval Administration shut off American Samoa from the outside world for 18 months, extending into 1920, refusing even mail delivery.2612 [3003] Because of its precautions, American Samoa remained the only country in the world in which not a single person died during the pandemic of 1918.2613 [3004] In neighboring Western Samoa, just a few miles away, more than one-fifth of the entire population died,2614 [3005] probably the highest percentage of any country in the world.2615 [3006] Simple quarantine does not work, because healthy-appearing people can spread the disease. But the U.S. Navy showed that isolation, in which one excludes both sick and healthy people, can. While Western Samoans died by the thousands, American Samoan records continued to reveal the normalcy of Samoan life, logging rare deaths from R20;eating sharkR17;s liverR21; or from R20;a falling coconut.R21;2616 [3007] Two other islands also escaped unscathedR12;St. Helena in the South Atlantic, famed as NapoleonR17;s place of exile,2617 [3008] and Yerba Buena Island right in the San Francisco Bay. As the pandemic raged along the California coast, the U.S. Naval training base stationed on Yerba Buena clamped down with a policy of total seclusion of its 4,000 inhabitants and practiced such preventive measures as literally blowtorching drinking fountains sterile every hour.2618 [3009] Total exclusion is more difficult on mainlands than on islands, but portions of northern and eastern Iceland2619 [3010] and one town in Alaska also successfully hid throughout the pandemic.2620 [3011] Coromandel, a resort town in New Zealand, cut itself off from the rest of the world using a rotating roster of shotgun-wielding vigilantes. It worked.2621 [3012] The only town in the continental United States to even come close was the remote mining settlement of Gunnison, Colorado.2622 [3013] While surrounding mining towns were being devastated2623 [3014] and the situation in Denver was described as R20;full of funerals all day and ambulances all night,R21;2624 [3015] the residents of Gunnison blockaded off the two mountain pass approaches with armed men2625 [3016] and escaped with one of the lowest reported infection rates in the country.2626 [3017] Similarly, U.S. Army commands tried to isolate entire military units. They R20;failed when and where [these measures] were carelessly applied,R21; but R20;did some goodR30;when and where they were rigidly carried out.R21;2627 [3018] Island nations like New Zealand are considering similar measures today, examining the feasibility of the immediate blockading of all people and importsR12;even food and medicineR12;when the pandemic hits. R20;To do that,R21; a New Zealand microbiologist realized, R20;all those people overseas on holiday would not be allowed in either. It sounds a good idea, but I would find it interesting to see whether it could ever be done.R21;2628 [3019] Mike Davis, author of the recent Monster at Our Door: The Global Threat of Avian Flu, was asked in an interview what he and his family plan to do when the pandemic hits. R20;There is the run-for-the-hills strategy, quite frankly,R21; he said, though he acknowledged this may not do much good. R20;Living in an unpopulated area may work for a handful of people. Maybe some survivalists can do this. But odds are that at least a quarter of Americans will be infected [and fall ill] in a pandemic flu.R21;2629 [3020] AmericaR17;s purple mountain majesties cannot fit 296 million people. (c) BirdFluBook.com | Home [3021] | Website by Lantern Media [3022] Bird Flu - Coughs and Sneezes Spread Diseases BirdFluBook.com [3023] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3024] Coughs and Sneezes Spread Diseases Sneeze Practicing social distancing techniques not only protects you from the crowds, it protects the crowds from you. If one actually falls ill, the best thing to do from a public health standpoint may be to self-quarantine at home to prevent the spread of the virus.2630 [3025] Otherwise, you are visiting a potential death sentence on everyone you meet. The extreme lethality of the current strain of H5N1 may actually work in humanityR17;s favorR12;people may be so ill and succumb so quickly that they are unlikely to get out of bed and spread it to others outside their households. Experts expect the virus may ratchet down its lethality in the interest of being more effectively spread. Of course, if we do become infected, it may be a day or two before we know it, so all but essential personnel should consider preparing for a prolonged R20;snow emergencyR21;-type isolation at home in the event of a pandemic.2631 [3026] Instead of a snow R20;day,R21; though, Osterholm compares it to preparing for a worldwide R20;12- to 18-month blizzard,R21;2632 [3027] although each wave may only last a matter of weeks in any particular locale.2633 [3028] Everyone should also begin getting into the habit of practicing what infectious control experts refer to as proper R20;respiratory etiquette.R21;2634 [3029] Most people know to cover their nose and mouth when they cough or sneeze, but most people are not doing it right. One should not cough or sneeze into oneR17;s hand. The current thinking is one should only cough into the crook of the arm.2635 [3030] Covering our nose and mouth can somewhat limit the dispersal of contaminated respiratory droplets, but when we cough into our hand, it becomes coated with virus that can then be transferred to everything from elevator buttons and light switches to gas pump and toilet handles.2636 [3031] A recent study found that the virus could be recovered from more than 50% of common household and day care center surfaces during flu season.2637 [3032] This is not surprising, given that up to five infectious viral doses have been measured in every drop of nasal secretions.2638 [3033] Coughing into the inner elbow area of oneR17;s arm or sleeve prevents the contamination of oneR17;s hands.2639 [3034] This takes practice, so we should all start rehearsing now. The Mayo Clinic has a slogan: R20;The 10 worst sources of contagion are our fingers.R21;2640 [3035] Fomite is the technical term for a contaminated physical object, like the archetypal doorknob, that can transmit disease among people. It comes from the Latin fomes, meaning R20;tinder.R21;2641 [3036] This sparking of an infectious blaze can be prevented through disinfection. At room temperature and humidity, influenza virus can survive intact for up to 48 hours on nonporous surfaces like metal or plastic and up to 12 hours on cloth, paper, or tissues,2642 [3037] but can be killed easily with a simple solution of household bleach. One tablespoon of chlorine bleach mixed in a gallon of water is a potent disinfectant. This diluted bleach solution can be sprayed on potentially contaminated common surfaces and left to sit for at least five minutes. Frequently used but infrequently disinfected objects, such as refrigerator handles and phone receivers, should not be missed.2643 [3038] The bleach solution can also be used to wash contaminated clothes and bedding, as research has shown that a shaken contaminated blanket can release infectious viral particles into the environment.2644 [3039] It must be chlorine bleach, meaning it should contain a chlorine-based compound like sodium hypochlorite. So-called R20;color-safeR21; bleaches should not be used as disinfectants. Wrapped in a stolen fatty coat from our cells, influenza viruses like H5N1 can lie in wait for days under the right conditions, patiently twiddling their thumbs until someone grasps the same doorknob. The virus still needs to bypass the skin barrier and find a way into the body, though. This is why we should get into the habit of avoiding touching our eyes, noses, and mouths whenever possible in public until we can wash or sanitize our hands.2645 [3040] The power of this simple intervention is illustrated by a study that showed that children aged four to eight taught to not touch their noses and eyes essentially halved their risk of contracting cold infections.2646 [3041] Although viruses like influenza can go airborne, studies of outbreaks at nursing homes suggest that this direct physical contact may play a significant role in its spread.2647 [3042] (c) BirdFluBook.com | Home [3043] | Website by Lantern Media [3044] Bird Flu - Washing Your Hands of the Flu BirdFluBook.com [3045] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3046] Washing Your Hands of the Flu Areas missed during handwashing The causal link between contaminated hands and infectious disease transmission in general is considered to be one of the best-documented phenomena in clinical science.2648 [3047] Eighty percent of all infectious diseases are transmitted by touchR12;from the common cold to R20;flesh-eatingR21; bacteria and Ebola. The director of Clinical Microbiology at New York University considers proper hand washing as serious a public health issue as smoking cessation.2649 [3048] Proper hand washing certainly seemed to work during the SARS epidemic. Those at high risk who washed their hands were found to be ten times less likely to contract the disease.2650 [3049] The oily envelope stolen from our cells makes the influenza virus especially sensitive to being washed away by the detergent quality of ordinary hand soap. As we learn in medical school, while soap may not kill a virus, the R20;solution to pollution is dilution.R21; Hand washing is meant to decrease viral counts below an infectious threshold. According to the influenza program officer of the National Institute of Allergy and Infectious Diseases, without a vaccine the R20;single most important step people can take to help prevent getting the flu is to wash their hands.R21;2651 [3050] People donR17;t wash their hands as often as they shouldR12;or even as often as they think they do. Ninety-five percent say they wash their hands after using a public toilet, yet the American Society for Microbiology published a survey of almost 8,000 people across five U.S. cities and found the true number to be only about two-thirds. Chicago topped the list at 83%; in New York City, the actual number fell to less than half.2652 [3051] Doctors are no exception. Though 100,000 Americans die every year from infections they contracted in the hospital2653 [3052] and though hand washing is considered the single most important measure to prevent such infections,2654 [3053] studies have shown that less than half of doctors follow proper hand-washing protocols in the hospital. A sample of doctors working inR12;of all placesR12;a pediatric intensive care unit were asked how much they thought they washed their hands. The average self-estimate of their own hand-washing rate was 73%, with individual responses ranging from 50% to 95%. These doctors were singled out and followed. Their actual hand washing rate? Less than 10%.2655 [3054] From an editorial in the New England Journal of Medicine: R20;It seems a terrible indictment of doctors that practices and protocols must be developed to take the place of something as simpleR30;as hand washing. Perhaps an even bigger concern for current medical practice, and one which should lead us all to do some soul searching, is that careful and caring doctors can be extraordinarily self-delusional about their behavior.R21;2656 [3055] The top excuses doctors use for not washing hands are: being too busy and dry skin.2657 [3056] When doctors do wash their hands, studies show that they only wash for an average of nine seconds.2658 [3057] Proper hand washing, according to the director of clinical microbiology at Mount Sinai, involves lathering with plenty of soap for 20 to 30 seconds (about the time it takes to sing the R20;alphabet songR21; three times at a fast tempo), rinsing, and then repeating for another 20 to 30 seconds.2659 [3058] CDC guidelines are similar, with additional reminders to wash between fingers and under the nails, and to soap into the creases around knuckles.2660 [3059] According to the World Bank Health Services Department, there is no evidence to suggest that hot (or even warm) water is better for hand washing. On the contrary, the colder the water is, the less skin damage is done by the detergents in the soap after repeated hand washing. Washing with warm or tepid water may be more comfortable, but one need not find hot water to wash effectively.2661 [3060] Most Americans profess to washing after changing a diaper or before handling food, but most donR17;t even claim to wash after coughing or sneezing.2662 [3061] At a minimum, experts advise, hands should be washed after every cough, every sneeze, and every time we shake hands with anyone. These simple recommendations may decrease the number of colds we get every year, the number of work days we miss, and the number of days we are laid up in bed. During a pandemic, they may even save your life.2663 [3062] (c) BirdFluBook.com | Home [3063] | Website by Lantern Media [3064] Bird Flu - ThereR17;s the Rub BirdFluBook.com [3065] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3066] ThereR17;s the Rub Views on hand sanitation are evolving rapidly. The 2005 World Health Organization consensus recommendations favor the use of alcohol-based sanitizing rubs or gels over hand washing for routine hand disinfection throughout the day. Products containing between 60% and 80% alcohol were found more effective than soap in every scientific study available for review. Enveloped viruses such as influenza are especially susceptible to topical alcohol sanitizers. Alcohol solutions not only were found to be more effective at eliminating germs, but require less time and cause less irritation than hand washing. Hand washing still has a place when hands are dirty or visibly contaminated with bodily fluids like respiratory secretions or blood, but for routine decontamination, alcohol-based products are the preferred method for hand sanitation.2644 [3067] Alcohol gel sanitizers can be found in any drugstore, but given the recommended frequency of use (after every bathroom use, before food preparation, before touching eyes, nose, or mouth in public) these products can get expensive in volume. In the event of a pandemic, all available stock would presumably be sold out almost immediately. Good news: You can make a cheaper, more effective version at home. Recipe for Alcohol Sanitizer Rub 4 cups 70% rubbing alcohol 4 teaspoons of glycerin Mix to make approximately one quart (liter). The glycerin acts as a humectant, or moisturizer.2665 [3068] Other moisturizers can be used, but glycerin is nontoxic, cheap, nonallergenic, and widely available. Vegetable glycerin can typically be found in natural food stores or online, and bulk rubbing alcohol can be found in drug stores in convenient 32-ounce (4-cup) bottles. During a pandemic crisis, all forms of alcohol are expected to sell out quickly, but made in advance this recipe could easily yield enough low-cost hand sanitizer solution for a whole neighborhood. Additionally, liquid alcohol sanitizer solutions have been found to be better at disinfecting hands than the alcohol gel products and can be just as conveniently stored in a small squirt bottles.2666 [3069] Rubbing alcohol can be acutely toxic if ingested.2667 [3070] Instead one can substitute a 140-proof scotch whisky. An additional advantage to using booze is that stockpiled liquor, along with cigarettes, gasoline, water, guns, canned vegetables and, oddly, cosmetics, has historically been among the most highly valued barter items in crisis situations.2668 [3071] Although there have been cases of serious alcohol intoxication in patients who drank bottles of alcohol sanitizer gel, only a negligible amount of alcohol is absorbed directly through the skin when properly used topically.2669 [3072] Alcohol gels and rubs are flammable, so they need to be kept away from flames and hot surfaces. There is one case in the medical literature of a U.S. health care worker who applied alcohol gel to her hands, immediately stripped off a polyester isolation gown, and touched a metal door before the alcohol had evaporated. The removal of the polyester gown created so much static electricity that an audible static spark was generated that ignited the unevaporated alcohol on her hands. This unlikely series of events can be avoided by rubbing oneR17;s hands together upon application until the alcohol has evaporated completely.2670 [3073] In October 2005, a global campaign involving a dozen countries was organized to launch a secret weapon against bird flu: instructions to improve hand hygiene by urging people to wash their hands and carry around a small plastic bottle of alcohol sanitizer.2671 [3074] Similar education campaigns need to be spread worldwide, convincing people to increase their standard of hygiene to the highest possible level by practicing safe coughing and sneezing practices, and sanitizing their hands before touching their faces after contact with others or with public surfaces.2672 [3075] And if people ever needed another reason to quit smoking or avoid secondhand smoke, now is the time. Keeping the respiratory lining healthy can help prevent the H5N1 virus from taking hold. Everything we need to know to survive a pandemic we learned in kindergarten. R20;Adhering to simple measures,R21; said a state deputy health commissioner, R20;may mean the difference between life and death.R21;2673 [3076] (c) BirdFluBook.com | Home [3077] | Website by Lantern Media [3078] Bird Flu - Masking Our Ignorance BirdFluBook.com [3079] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3080] Masking Our Ignorance What is the best use of masks and the best mask to use? San Francisco is one of the cities in 1918 that made mask wearing compulsory. Citing a slogan the Italian Supreme Command had printed on every gas maskR12;R20;Who leaves this mask behind, diesR21;R12;the San Francisco mayor threatened to arrest anyone unmasked.2674 [3081] Within 36 hours, the SFPD had hauled in 175 R20;mask-slackers.R21;2675 [3082] The main mode of influenza virus transmission is coughed and exhaled respiratory droplets of virus-laden mucus and saliva. Conversational speech alone can produce thousands of these tiny droplets,2676 [3083] which tend to settle out of the air within minutes, extending a few feet into the personR17;s immediate environment.2677 [3084] Infection occurs when one of these droplets lands on the surface of another personR17;s eye, in his mouth, or up her nose, or is planted in one of these three places with contaminated hands.2678 [3085] Wearing a mask may help in two ways: by thwarting droplet contact with mucus membranes and by reminding the mask wearer not to touch his or her face.2679 [3086] There is also a concern about inhaled fecal droplets aerosolized by toilet flushing. Live virus has been isolated from the diarrhea of a child dying from H5N1, raising the possibility that virus could be spread from human to human via a fecal-oral route as well. Experiments using fluorescent-stained water have demonstrated that not only are toilet seats significantly contaminated, but a flume of aerosolized toilet waterR12;reaching the standing height of a childR12;is created when a toilet is flushed. Good bathroom hygiene should include lowering the toilet lid before flushing.2680 [3087] During a pandemic crisis, if we are forced to venture out for any reason, wearing masks in public restrooms, and in all crowded public areas, may be prudent. There are essentially only two economical optionsR12;surgical masks and N95 masks. The R20;NR21; in N95 stands for NIOSHR12;the U.S. National Institute for Occupational Safety and HealthR12;and 95 reflects the filtering efficiency of the mask, effectively filtering out 95% of particles of a certain size.2681 [3088] Surgical masks are typically made out of paper with a gelatinous layer and must be changed every four hours or when they become wet with saliva or other fluid, whichever comes first.2682 [3089] Although they do not have N95R17;s filtration capacity or resilience, the advantage of surgical masks is better breathabilityR12;causing less thermal and physical discomfort and fatigue2683 [3090] R12;and better affordability. Surgical masks are sold at pharmacies for pennies; N95 masks are available at hardware stores for a dollar or more each. Whether either mask would provide sufficient protection in a pandemic, though, is a matter of controversy.2684 [3091] There is no doubt that surgical masks can filter out some larger respiratory droplets. During the SARS outbreak, high-risk personnel wearing surgical masks seemed 15 times less likely to contract the disease.2685 [3092] Because droplets are the primary means by which influenza spreads, authorities such as the U.S. Department of Health and Human Services have settled upon surgical masks as amply protective,2686 [3093] especially given their cost-effectiveness.2687 [3094] Although droplet spread is the principal method, true airborne transmission of influenza virus in particles too small to be filtered out by surgical masks has been documented.2688 [3095] Yes, respiratory droplets settle to the ground, but sweeping the floor as much as a day later can agitate tiny desiccated particles of virus back into the air, which may pass through surgical masks and have been shown to be infectious in a laboratory setting.2689 [3096] N95 masks are made out of a special, nonwoven polypropylene fabric that generates static electricity to trap tiny particles.2690 [3097] No mask provides a perfect barrier, but N95 masks would be expected to provide greater protection to airborne virus than surgical masks.2691 [3098] R20;N100R21; masks (even more expensive) filter out an estimated 99.7% of fine particles.2692 [3099] Whichever, they need to be worn and disposed of properly. A gap between face and mask of even a few millimeters can render a mask ineffective. The presence of beard stubble, for example, can undermine a maskR17;s efficacy.2693 [3100] In occupational settings, facial hair is shaved and N95 masks are meticulously fitted to match each individualR17;s face for size and shape and often tested using bitter-tasting test aerosols to double check for an airtight seal. In a household setting, the best option would probably be to duct-tape the entire periphery of the mask to oneR17;s clean-shaven face.2694 [3101] Handling or reusing worn masks risks hand contamination.2695 [3102] If need be, masks may be reused by the same person unless they become damaged, wet, dirty, or hard to breathe through.2696 [3103] Ideally, though, all masks should be used only once2697 [3104] and properly disposed of using gloves.2698 [3105] None of these masks protect the eyes. Those in contact with infected persons should consider practicing the R20;m3gR21; approach popularized during SARS2699 [3106] R12;mask, gown, gloves, and goggles.2700 [3107] Gowns should ideally cover the body and arms, and be tucked under the gloves at the wrist. Surgical or examination gloves are designed for single use and disposal. Washing or disinfecting gloves can cause deterioration of the thin material. Proper utility gloves, on the other handR12;the rubber gloves used for housekeeping choresR12;can be decontaminated and reworn.2701 [3108] And silicone-seal swimming goggles are the recommended eyewear. Wear glasses? Tightly fitting safety goggles with tape over air vents will help protect your eyes. Even with these precautions, influenza is so contagious that exposure to crowded public settings or contact with potentially infected persons should be kept to an absolute minimum. During a massive bird flu outbreak in the Netherlands in 2003, investigators could not demonstrate a protective effect on poultry workers of masks and safety goggles. The official government account suspected that workers became infected by taking their contaminated overalls off after they had removed their masks and goggles.2702 [3109] Considering the Netherlands outbreak and the lack of data from 1918 showing that compulsory masking was an effective public health strategy, the World Health Organization is permissive but not encouraging of national laws enforcing mask wearing by decree in national pandemic response plans.2703 [3110] In terms of individual strategies, the best recommendation may be what finally shook out of the SARS crisis:2704 [3111] in public, surgical masks for the sick and N95 masks for the healthy.2705 [3112] The CDC is encouraging all hospitals, physiciansR17; offices, and other health care providers to issue surgical masks to all incoming patients showing any evidence of a respiratory illness as part of R20;universal respiratory etiquette.R21; In Japan, this is already routinely practiced. When people in Japan with a cold or cough need to go out into a public setting, they will often wear a surgical mask. This civic mindedness is a practice worth emulating.2706 [3113] Like the alcohol, it seems prudent to stockpile masks before the next pandemic hits. Two companies supply up to 90% of the worldR17;s surgical and N95 masks from plants overseas2707 [3114] and neither could meet a significant jump in demand, in part because the necessary supply of component parts from second- and third-tier countries would presumably collapse along with the rest of international trade.2708 [3115] Right now, both companies are reportedly working at 95% capacity and predict that it would take years to build another factory to make more masks.2709 [3116] R20;The bottom line,R21; Osterholm said, R20;is we will run out of masks very quickly.R21; He asks everyone to imagine the fear and panic, people thinking, R20;I canR17;t get a vaccine, I canR17;t get an antiviral drug that will work and I canR17;t get a mask. What do I do?R21;2710 [3117] When Turkey confirmed the presence of H5N1 just in birds, masks sold out in Serbia in one day.2711 [3118] Sales of masks in the United States have already jumped with one New York retailer describing a leap from 25 sold per week to 5,000.2712 [3119] Masks are not easily replicated at home. When mask prices shot through the roof in Asia during the SARS epidemic,2713 [3120] some strapped bras to their faces.2714 [3121] Improvised masks made out of woven material, such as cotton cloth or gauze, however, offer little protection from airborne pathogens (but do remind the wearers not to touch their faces in public before decontaminating their hands). Some countries are stocking up on masks in addition to antivirals.2715 [3122] No such stockpile has been planned in the United States, leaving it up to individuals to arrange for their own safety. The North American investment firm BMO Nesbitt Burns underscored the need to take personal responsibility in its report on pandemic planning. R20;Face masks would fly off the shelves and restocking would be impossible,R21; its global economic strategist wrote. R20;Black markets in face masks (as an example) would develop and crime would become a serious problem. The military and National Guard, as well as police and firefighters, would be needed to maintain the peace, and yet their ranks will be depleted by illness.R21;2716 [3123] Having the tools on hand (and face) to practice simple hygiene measures may improve oneR17;s chances of falling into the half lucky enough only to watch others become ill. (c) BirdFluBook.com | Home [3124] | Website by Lantern Media [3125] Bird Flu - Home Health Aid BirdFluBook.com [3126] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3127] Home Health Aid If despite our best precautions we fell ill, how could we take care of ourselves at home if the health care system broke down? The most important thing may be to start antivirals as soon as possible after the first symptoms begin. By the time the pandemic strikes oneR17;s area, the constellation of symptoms for the particular pandemic strain should be well known. Every news outlet will presumably be all pandemic, all the time. Onset is sudden. The French call it la grippe, conjuring images of being seized by disease. People describe it as R20;like being hit with a truck.R21; The flu generally strikes with sudden fever and chills, cough, muscle aches, fatigue, and weakness such that itR17;s hard to get out of bed. The flu is hard to miss. Although high fever in children for any reason can cause them to vomit, gastrointestinal symptoms are rare with influenza.2717 [3128] The so-called 24- or 48-hour R20;stomach flu,R21; with nausea, vomiting, and diarrhea, is an unfortunate misnomer. As mentioned in chapter 9, the R20;24-hour fluR21; is most often a case of food poisoning (viral food-borne gastroenteritis), not influenza.2718 [3129] The common cold, in contrast to influenza, is more of a localized, sniffly-sneezy-sore-throat-stuffy-nose phenomenon, lacking the systemic flu symptoms of extreme fatigue, fever, and severe aches and pains. Cough, headache, and chest discomfort can accompany either, but tend to be more severe in influenza.2719 [3130] With or without antivirals, the foundation of treatment becomes rest and fluids. Fatigue, weakness, and muscle aches are your bodyR17;s way of telling you to stay in bed. Your body is no dummy. Not only will you be less likely to spread the disease to others, but bed rest lets your body proportion more energy to mobilize initial defenses.2720 [3131] Avoiding exertion also reduces the likelihood of gasping virus further into the lungs with deep inhalation.2721 [3132] In fact, one guess as to why more young men than young women died in 1918 R20;may be due to the tendency of many men, out of necessity or masculine impulse, to continue working rather than resting when they were sick.R21;2722 [3133] Next to antivirals, the best thing one can typically do to survive the flu is to keep properly hydrated by sipping at least one cup of water, tea, juice, soup, or other nonalcoholic beverage every waking hour. ThatR17;s two to four quarts of liquid a day, which loosens pulmonary secretions to help rid the body of the virus2723 [3134] and prevent the dehydration that accompanies fever.2724 [3135] If you or the person you are nursing isnR17;t eating, electrolytes can be added to the rehydration solution. Recipe for Rehydration Solution 1 quart (or liter) drinking water 2 tablespoons of sugar 1/4 teaspoon of table salt 1/4 teaspoon of baking soda Mix to make approximately one quart If available, adding 1/4 teaspoon of salt substitute (potassium chloride), 1/2 cup of orange juice or coconut water, or half of a large mashed ripe banana would add potassium. The solution can be flavored with lemon juice or a sugar-free powdered drink mix. If baking soda is unavailable, substitute another 1/4 teaspoon of salt.2725 [3136] If a person is too sick to drink, fluid can be given literally drop by drop until the patient recovers.2726 [3137] Treating influenza outside of a medical setting is less a matter of feeding or starving a fever than it is of drowning it. Fever reduction is a controversial subject. Fever may be uncomfortable, but it has a beneficial effect on the course of many infections. Elevated temperatures have been shown to inhibit influenza virus replication. Again, our body usually knows best.2727 [3138] Artificially breaking a fever with drugs like acetaminophen (Tylenol) or ibuprofen (Motrin) may make us feel better, but we may be undermining our bodyR17;s ability to fight. A cool cloth on the forehead can make us feel better without lowering our internal virus-fighting fever. Drugs should be considered, though, when the febrile discomfort or muscle aches interfere with sleep, which is also important for recovery. High feversR12;over 104degreeFR12;should definitely be treated. A combination of acetaminophen and ibuprofen, both taken at the same time, and tepid-water sponge-baths should successfully bring down almost any high fever. Aspirin should never be given to a child because of the risk of a rare but serious side effect known as ReyeR17;s syndrome.2728 [3139] Chicken soup might be out of the question during a bird flu pandemic, but warm liquids in general can relieve symptomatic congestion and may also beneficially raise the temperature of the respiratory passageways.2729 [3140] The lay press has touted the anti-viral benefits of a chemical compound found naturally in grapes called resveratrol.2730 [3141] In laboratory experiments performed on infected mice, injection with resveratrol did indeed seem to enhance survival,2731 [3142] but the researchers used massive doses in a non-oral route in nonhuman subjects.2732 [3143] The human equivalent would mean drinking four gallons of red wineR17;s worth of the compound daily.2733 [3144] So while resveratrol may hold some future pharmacological potential, grape juice may be no better than any other hydrating liquid. With or without Tamiflu, no combination of questionable remedies touted over the internet has been shown to trump bed rest and fluids to improve survival. (c) BirdFluBook.com | Home [3145] | Website by Lantern Media [3146] Bird Flu - Collateral Damage BirdFluBook.com [3147] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3148] Collateral Damage Surviving the disease is only one part of surviving the pandemic. Prominent financial analysts are predicting that the pandemic could trigger an unprecedented global economic collapse.2734 [3150] The chief of Pediatric Infectious Disease at Winthrop University colorfully expressed in the 2005 Pediatric Annals R20;Two masters of suspense, Alfred Hitchcock and Stephen King, may have been closer to the truth than they ever would have believed. Both birds and a super flu could bring about the end of civilization as we know it.R21;2735 [3151] The U.S. National Intelligence CouncilR17;s 2020 Project R20;Mapping the Global FutureR21; identified a pandemic as the single most important threat to the global economy.2736 [3152] Realizing that the prospects for preventing the pandemic are practically nonexistent, chief scientists like Osterholm are working with the business community to help ensure an infrastructure for survivors of what is being predicted in policy journals as the R20;shutdown of the global economic system.R21;2737 [3153] Speaking as associate director of the National Center for Food Protection and Defense for the Department of Homeland Security to a conference of agricultural bankers, Osterholm laid it out: R20;This is going to be the most catastrophic thing in my lifetime. When this situation unfolds, we will shut down global markets overnight. There will not be movement of goods; there will not be movement of people. This will last for at least a year, maybe two.R21;2738 [3154] These could well be years characterized by R20;utter chaos,R21;2739 [3155] he said; R20;panic would reign.R21;2740 [3156] The major North American brokerage firm BMO Nesbitt Burns was the first to describe the global economic implications, suggesting that a pandemic could set off a catastrophic downturn akin to the Great Depression. R20;A pandemic would be even worse,R21; its report reads, R20;in that many would avoid homelessness and soup lines having paid the ultimate price.R21;2741 [3157] The firmR17;s chief economist pointed out a big difference between a pandemic crash and the Great Depression. R20;We wonR17;t have 30% unemployment,R21; she said, R20;because frankly, many people will die.R21;2742 [3158] Attempts have been made to calculate the costs. An Oxford University group estimated the cost of a mild pandemic at trillions of dollars,2743 [3159] but considered it impossible to guess the price tag of a more virulent pandemic that could leave the world economy in shambles for years.2744 [3160] Analysts point to SARS, the only other truly global outbreak of a respiratory virus.2745 [3161] Only a few dozen deaths in Canada and, according to the Minister of State for Public Health, the entire economy R20;went to its knees.R21;2746 [3162] Experts note that we were R20;very lucky that SARS was SARSR21; and not something like pandemic influenza, which would make SARS R20;look like a vacation.R21;2747 [3163] Part of the economic paralysis would arise from the fear of contagion. Laurie Garrett is the first reporter ever to win all three of journalismR17;s top R20;PR21; awards (the Peabody, the Polk, and the Pulitzer). At a Council on Foreign Affairs meeting, she tried to ground the dialogue by discussing the possible implications for a city like Washington, D.C. R20;An influenza virus like H5N1,R21; she said, R20;loves doorknobs. It loves the poles in the Metro. It loves every entrance, every common surface that we touch.R21; She described the environmental persistence of the virus. So all of Washington, D.C., is full of commonly touched surfaces, and all of a sudden you would see this city utterly paralyzed. Government would stop. You could not imagine any way that people would feel safe commuting in and out of the District, going to government offices, getting on the Metro, all the things that are of the essence of how you keep this place moving around. All IR17;m saying is that if you amplify your imagination of what this would mean to Washington, to all the most important hubs of the global economy, you easily can see the impact this would have on the global economy.2748 [3164] Similar descriptions have been made of the Big Apple shaken to its core. As associate dean of Columbia UniversityR17;s School of Public Health, Irwin Redlener has been working with New York City officials to ready the metropolis for the coming pandemic. Redlener expects that attempts will be made to lock down entire sections of the city under quarantine. R20;The city,R21; he said, R20;would look like a science fiction movie.R21;2749 [3165] As with Hurricane Katrina, itR17;s not enough to ride out the storm; we also have to weather the aftermathR12;the shortages, the loss of essential services, and the ensuing social chaos. With supply chains broken as borders slam shut,2750 [3166] major global shortages are expected for everything from soap, paper, and light bulbs to regular medications, gasoline, and parts for repairing military equipment and municipal water supplies.2751 [3167] At a pandemic preparedness conference, Garrett sat quietly through presentation after presentation on the various facets of avian influenza. R20;Well yes,R21; she asked when the Q & A period finally arrived, R20;but how will we eat?R21;2752 [3168] We were much more self-sufficient in 1918.2753 [3169] As late as the 1960's, most food in the United States was sourced within 100 miles of the supermarket in which it was sold.3186 [3170] Our globalized food supply is now more vulnerable to disruption. Today, since our global economy is now built upon just-in-time inventory control, companies have minimal stockpiles of raw materials or finished goods.2754 [3171] Modern corporations no longer have warehouses brimming with monthsR17; worth of inventory. Grocery stores rarely have more than a few daysR17; supply of popular goods stored, and the Grocery Manufacturers Association has been pushing for even tighter inventory restrictions. The chief executive of the Council of Supply Chain Management Professionals told the Wall Street Journal that food retailers R20;canR17;t afford a just-in-case inventory.R21;2755 [3172] The threat of a bad winter storm can lead to regional shortages of key commodities;2756 [3173] imagine those shortages dragging on for months.2757 [3174] A personal supply of Tamiflu is clearly not enough. Some countries have started stockpiling essential goods. France spent the latter part of 2005 increasing its stocks of protective masks from 50 million to 200 million.2758 [3175] While President Bush was expressing confidence on NBCR17;s Today show that the government would develop a plan R20;to handle a major outbreak,R21;2759 [3176] some world leaders were bolstering words with action. R20;No obstacle,R21; FranceR17;s President Chirac told his Cabinet, R20;notably economic or financial, will get in the way of useful measures to protect the health of the French people.R21;2760 [3177] Congress was informed by an occupational health specialist that not only will grocery stores be empty, but we might lose power, water, and phone service. A World Economic Forum simulation suggested that the internet would shut down within two to four days.2761 [3178] Osterholm told Oprah, R20;Go ask the city of Chicago, R16;How much chlorine do they have?R17; Today, many of the cities in this world have no more than five to seven days of chlorine on hand to actually use and purify that water supply.R21;2762 [3179] We might be forced to endure deep winter with no heat.2763 [3180] The crumbling of critical infrastructure could be a result, in part, of rampant absenteeism.2764 [3181] R20;Billions would fall sick,R21; a WHO spokesperson explained, R20;billions more would be too afraid to go to work, leading to a collapse of essential services.R21;2765 [3182] Top-level UN pandemic catastrophe simulations suggest that maintaining water, power, and provision of food for the healthy may save more lives than focusing on treatment of the sick.2766 [3183] Like many police in New Orleans after Katrina, even essential workers such as doctors might simply not show up for work.2767 [3184] They would be asked to operate in overflow R20;hospitalsR21;R12;gymnasiums, arenas, armoriesR12;anywhere the sick could be warehoused. Garrett predicts that these makeshift sickbays might deteriorate into post-Katrina Louisiana Superdome squalor.2768 [3185] Likely most health care workers would have no access to vaccines or antivirals. Under these conditions, Osterholm wonders, R20;Would you show up to work?R21; R20;Would your loved ones show up to work if they were being exposed to a life threatening infection with virtually no protection?R21;2769 [3186] (c) BirdFluBook.com | Home [3187] | Website by Lantern Media [3188] Bird Flu - Corpse Management BirdFluBook.com [3189] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3190] Corpse Management Disposal of the dead, referred to in crisis management circles as R20;corpse management,R21;2770 [3191] presents special problems for public health officials. "We talk about how people should bury their dead in their backyards, how far from the septic systems," explains the director of the King County public health department in Seattle. "In case you're wondering, it's $20 apiece for high-quality body bags.R21;2771 [3192] During the last pandemic, the average time between when a coffin was constructed and when it was buried in the ground was months. Today, with our just-in-time inventory system, itR17;s under three weeks.2772 [3193] Osterholm predicts, R20;We will run out of caskets overnight.R21;2773 [3194] Crematorium capacity is equally limited.2774 [3195] There will be no place for the dead.2775 [3196] R20;In our lifetime, we have not seen a disease sweep through a community and people die so fast that thereR17;s no one to take care of them at the hospital and thereR17;s no one to bury them,R21; says Greg Poland, M.D., chair of the Vaccine Research Group at the Mayo Clinic. R20;ThatR17;s what will happen in a pandemic. It would be more deaths than all the worldR17;s wars in all of human history. All within the space of 6 to 18 months.R21;2776 [3197] In the U.K., officials have been scouring the countryside for suitable sites for mass graves as part of R20;Operation Arctic Sea,R21; the British governmentR17;s emergency pandemic simulations.2777 [3198] Their preparedness plan considers creative solutions such as mobile inflatable mortuaries big enough to hold hundreds of bodies.2778 [3199] In Australia, officials realized that even with mandatory cremations and all their crematoria working 24 hours a day, 7 days a week without disruption, bodies still may pile up. If so, the plan is then to have Army engineers with refrigerated trucks dispose of bodies in R20;communal burials.R21; The government realizes that this may raise a R20;multitude of issues in our multicultural community.R21; A spokesperson for the Health Department pleaded, R20;We need all religious societies to respect the fact they may need to be buried communally in mass graves.R21;2779 [3200] (c) BirdFluBook.com | Home [3201] | Website by Lantern Media [3202] Bird Flu - Bird Flu Vultures Lining Up BirdFluBook.com [3203] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3204] Bird Flu Vultures Lining Up According to public opinion polling, the people most concerned about the coming pandemic are those with salaries higher than $100,000. Further analysis suggested that this was not due to higher education levels, but that R20;[p]eople with higher incomesR30;have more to loseR30;.R21;2780 [3205] Investment banking firms like Citigroup, though, see a sterling silver lining, the opportunity to profoundly profit from the pandemic. We are asked to think real estate deals. R20;Soaring death rates would puncture the housing bubble and create vast housing oversupply,R21; predicts one banking firm. R20;To the extent that a disproportionate share of 20- to 40-year-olds would die, housing markets would weaken in response to excess supplyR30;. Property values would fall, and some would be had later at bargain-basement prices.R21;2781 [3206] Foreign exchange speculators will be making a killing. R20;Negative news,R21; a senior foreign exchange dealer explained, R20;is a chance to make a profit.R21;2782 [3207] While stock in life insurance companies is not considered a good bet, An InvestorR17;s Guide to Avian Flu reads, R20;Certainly there would be winners, such as funeral homes and other R16;death-relatedR17; businessesR30;.R21;2783 [3208] Citigroup Investment Research recommends selling off stock in shopping malls, air travel, and luxury goods, but picking up shares of cleaning-product makers like Clorox, home entertainment, and telecommunications. The defense sector is also heralded as a long-term winner.2784 [3209] If history truly is a good teacher, we should expect opportunistic advertising. In 1918, Colgate toothpaste swore that R20;good teethR21; meant R20;good health.R21;2785 [3210] We should expect price gouging. In 1918, undertakers tripled coffin prices.2786 [3211] The Mercatus Center, a corporate-funded2787 [3212] think tank at George Mason University, is in favor of all price-gouging prevention laws being repealed in preparation for the pandemic. Many states have laws prohibiting price gouging during national emergencies. During a blackout, for instance, it is against the law to suddenly spike the price of flashlights in certain states. The Mercatus Center argues that price gouging is an effective way to prevent shortages. The Center apparently imagines some sort of trickle-down benefit of effectively restricting critical supplies to the wealthy. R20;We should not obsess,R21; the CenterR17;s general director writes in its official report Avian Flu: What Should Be Done, R20;over whether R16;the richR17; or R16;the poorR17; are obtaining a greater share of treatment or prevention.R21;2788 [3213] All will not be roses for the wealthy who survive. R20;[M]any of the comforts of our daily life,R21; one expert explains, R20;lettuce in winter, light bulbs, new sneakers, are grown for us or made for us by people who live in developing countries. If their workforces are decimated, we will feel the knock on effects.R21;2789 [3214] Describing the R20;implications for all thisR21; as R20;really fascinating,R21; one of CanadaR17;s foremost economists predicts that R20;[c]learly at the end of the crisis there would be many bargains to be hadR30;.R21;2790 [3215] But people will need to be in a financial position to exploit the situation. Banking conglomerate BMO Nesbitt Burns published a report instructing the six-figure income set on how to best play their cards. Those who can hoard cash will R20;ultimately benefit by buying real estate, farms, businesses, and stocks at extraordinary prices.R21; BMO Nesbitt Burns admits that this may sound R20;rather callous,R21; but rationalizes that this is the way it has always been done. In the lead-up to the Great Depression, goes its explanation, those with liquid assets were able to R20;scoop up the property of those who were heavily indebted.R21;2791 [3216] The pandemic may be good for business. The 1918 pandemic was followed by the roaring R17;20s when, we are reminded, among the lucky survivors R20;there were hordes of newly-rich peopleR30;and many of the Old Rich had become fabulously rich.R21; With the right pandemic portfolio, investment firms advise, survivors of the pandemic would not need to rely on luck R20;to take advantage of the wide array of cheap assetsR30;.R21;2792 [3217] Post-pandemic wages may rise thanks to the R20;accompanying negative shock to population and the labor force.R21; The same boon evidently followed the Black Plague, with some historians arguing that rents dropped and wages rose. A financial analysis of 1918 claimed that the pandemic had a R20;large and robust positive effectR21; on per-capita income growth, calculating exactly how much positive economic growth could be attributed to each additional death.2793 [3218] During the 2005 Council on Foreign Relations Conference on the Global Threat of Pandemic Influenza session titled, R20;What Would the World Look Like After a Pandemic?,R21; bioterrorism expert Yanzhong Huang, the director of Center for Global Health Studies at Seton Hall University, remarked, R20;I want to point out that this negative shock to the population growth is not necessarily a negative thingR30;.R21;2794 [3219] There is some financial advice in these pandemic investment reports applicable to the general public. Commonsense appeals not to worsen oneR17;s personal debt seem like sound advice.3795 [3220] Other recommendations appear less valid. The president of Global Trends Investments recommends fallback to precious metals and hard currency,2796 [3221] but with so many deaths expected, large-scale estate liquidations of jewelry might undercut the gold market.2797 [3222] A lesson from Katrina is that local economies might revert to systems of barter.2798 [3223] Money, one expert from the British Institute for Animal Health asserts, R20;would be meaningless.R21;2799 [3224] Should the worst-case scenario come to pass, the president of investment research firm WBB Securities declared (perhaps only half jokingly) that R20;the best bets may be canned goods and shotgun shells.R21;2800 [3225] (c) BirdFluBook.com | Home [3226] | Website by Lantern Media [3227] Bird Flu - R20;We have learned very little that is new about the disease, but much that is old about ourselves.R21; BirdFluBook.com [3228] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3229] R20;We have learned very little that is new about the disease, but much that is old about ourselves.R21; R12;Frederick C. Tilney, on the 1916 polio epidemic in New York2801 [3230] It may be too late to soften the disease impact of the pandemic, but it is not too late to prepare. R20;We need to take steps so that people who are spared by the pandemic influenza virus arenR17;t done in by starvation, cold, chronic diseases, or contaminated water,R21; writes one prominent risk management specialist.2802 [3231] R20;We donR17;t want people who are spared by the virus done in by riots either.R21; Civil society is expected to disintegrate, triggering violent social disturbances as populations attempt to flee contaminated areas or engage in mass looting.2803 [3232] After Katrina hit, it took only 48 hours for 20% of New OrleansR17; police force to disappear and drug addicts in withdrawal to claim the streets with gunfire.2804 [3233] FEMA director Brown said his agency was forced to work R20;under conditions of urban warfare.R21;2805 [3234] And thatR17;s only one city in crisis. Experts fear that civil unrest could be a tipping point for instability in a number of governments around the world R20;as their economies implode.R21;2806 [3235] There is a concern that even early on in unaffected countries, panic and chaos could erupt as the world media reports the daily advance of the pandemic.2807 [3236] One CDC economist was asked to predict the social fallout. That was outside his realm, he replied, R20;Go ask the fiction writers what could happen.R21;2808 [3237] Nature commissioned its senior reporter in Paris to write a fictional yet realistic account [3238] of how an influenza pandemic could be expected to unfold. It can be read in full at tinyurl.com/h5ylq [3239] . It is fiction, but not fantasy. In 1918, orderly life in America began to collapse. Families stopped taking care of each other. In its 1919 An Account of the Influenza Epidemic, the Red Cross reported that R20;people [were] starving to death not from lack of food but because the well were panic stricken and would not go near the sick.R21;2809 [3240] Social services begged neighbors to take in children whose parents lay dying or dead. A historian reported, R20;The response was almost nil.R21;2810 [3241] Victor Vaughn, Surgeon General of the U.S. Army, described as R20;a careful man, a measured man, a man who did not overstate to make a point,R21; warned, R20;Civilization could have disappeared within a few more weeks.R21;2811 [3242] In 1918, the social order broke down. The chief diagnostician in the New York City Health department summarized the impact of the pandemic on the mental state of its victims: R20;Intense and protracted prostration led to hysteria, melancholia, and insanity with suicidal intent.R21;2812 [3243] Violence broke out. In San Francisco, a Health Department inspector shot a man for refusing to wear a mask. In Chicago, a worker shouted, R20;IR17;ll cure them my own way!R21; and then proceeded to cut the throats of his wife and four children.2813 [3244] Riots broke out. The War Department, overwhelmed by the pandemic, was unable to assist in controlling the civic disorder at home.2814 [3245] All levels of government were severely crippled, affecting public services across the board.2815 [3246] Undertakers had to hire private armed guards around their valuable coffins.2816 [3247] The official U.S. pandemic preparedness plan predicts much the same scenarios developing today.2817 [3248] This doesnR17;t surprise researchers in the field. What happens when people in South Side Chicago or Compton or the Bronx see people dying of this, while others get the care they need? What happens if the hospitals which traditionally serve the needs of the inner city begin to run out of beds? Do we think that people will sit pat in the projects and poor neighborhoods of our country and watch as their family and friends, their very communities, die? I donR17;t see why there wouldnR17;t be civil unrest.2818 [3249] When Chinese villagers realized that information had been withheld by provincial leaders during the SARS outbreak, they rioted against proposed quarantine centers that were being prepared to isolate outsiders. Asked why information had been withheld from the villagers, one bureaucrat told a news correspondent, R20;They just wonR17;t understand.R21;2819 [3250] Open communication is considered vital to maintaining trust. As former senator Sam Nunn said, playing the U.S. President in Dark Winter, a smallpox bioterrorist exercise,2820 [3251] R20;The federal government has to have the cooperation from the American people. There is no federal force out there that can require 300 million people to take steps they donR17;t want to take.R21;2821 [3252] This means starting the national debate now. WhoR17;s going to get the antivirals, the vaccine, the hospital bedR12;the 70-year-old grandparent, the 30-year-old mother of two children, or the children themselves? R20;People in America are not used to that kind of rationing,R21; a CDC economist told Science.2822 [3253] The chief of clinical bioethics at the U.S. National Institutes of Health recently published a suggestion that proved controversial with those in the medical field.2823 [3254] He proposed that children should be given precedence, even if just prioritizing doctors might save more lives, based on whatR17;s been called the R20;fair inningsR21; principle2824 [3255] that R20;each person should have an opportunity to live through all the stages of lifeR30;.R21;2825 [3256] The time for this discussion is now, before the pandemic has begun.2826 [3257] Social psychologists describe a chilling effect on human nature, values, and motivations visited upon us by plagues throughout history. A chronicler of the Black Death wrote in 1348, R20;Father abandoned child, wife husband, one brother anotherR30;. And no one could be found to bury the dead for money or friendship.R21; He himself was forced to bury his five children with his own hands.2827 [3258] According to a distinguished medical historian, the general attitude can be summed up by a line from Ben JohnsonR17;s The Alchemist in which, during a plague outbreak, one character tells another, R20;Breathe less, and farther off!R21;2828 [3259] This base human tendency, born of fear and distrust, can fester into a Lord of the Flies social pathology of hate.2829 [3260] The bubonic plague led to violent attacks upon minorities such as Jews, especially after one Jew famously R20;confessedR21; (under torture) to poisoning wells across Europe.2830 [3261] More Jews may have been murdered by their countrymen than by the Black Death.3170 [3262] Such attacks led to further spread of the disease as persecuted peoples fled affected areas en masse. Dominant social groups seized the situation to further socially conservative agendas, under the flag of R20;GodR17;s punishment for sin.R21;2831 [3263] Scapegoating is endemic throughout medical history. Since the early 16th century, for example, syphilis has been called morbus gallicus (the R20;French poxR21;) in Italy, le mal de Naples (the R20;disease of NaplesR21;) in France, the R20;Polish diseaseR21; in Russia, the R20;Russian diseaseR21; in Siberia, the R20;Portuguese diseaseR21; in India, the R20;Castilian diseaseR21; in Portugal, and the R20;British diseaseR21; in Tahiti.2832 [3264] In 1918, the rich blamed the poor and the poor blamed the rich for the emergence of the R20;Spanish LadyR21;R12;itself a xenophobic, misogynistic label for the flu. Swedish socialists staged a general strike proclaiming, R20;Flu Avenges the Workers.R21; The poor areas of the world did suffer disproportionately, but in some cities such as London, the death rate was R20;as high in prosperous Chelsea and Westminster as in the slums of Bermondsey and Bethnal GreenR21; for the first time in the history of public health records.2833 [3265] As one expert noted, R20;[I]nfluenzaR17;s very very democratic.R21;2834 [3266] The 1918 pandemic was fodder for racists and anti-Semites. In Baltimore under Jim Crow segregation, the hospitals were closed to blacks at their moment of greatest need. Once the pandemic passed, Baltimore officials then defended the cityR17;s poor public health performance by attributing the cityR17;s elevated mortality rate to its proportion of black residents.2835 [3267] The Poles blamed the Jews, whom they called R20;a particular enemy to order and cleanliness.R21;2836 [3268] As reviewed in the New England Journal of Medicine, this is R20;sadly neither the first nor the last, of the social scapegoating that is one of the most common, ugly, and unproductive features of epidemics in human society.R21;2837 [3269] Victims of infectious disease are blamed and shunned to this day. During the SARS epidemic, artists of Chinese descent were denied access to a middle school in New Jersey.2838 [3270] Some of the employees of the company that fell prey to the first anthrax case were doubly victimized. Family physicians refused to see them, and their kids were turned away from schools.2839 [3271] The religious intolerance and victim blame of 1918 was repeated in 2005 following Hurricane Katrina.2840 [3272] Founder of the Christian Coalition of America and former presidential candidate Pat Robertson linked both Katrina and terrorist attacks to legalized abortion.2841 [3273] The director of the fundamentalist Christian organization Repent America prayed, R20;May this act of God cause us all to think about what we tolerate in our city limits, and bring us trembling before the throne of Almighty God.R21;2842 [3274] A Christian leader within New Orleans agreed that it was GodR17;s mercy that purged New Orleans. R20;New Orleans now is abortion free,R21; he said. R20;New Orleans now is Mardi Gras free.R21;2843 [3275] 1918 brought out the worst in people, but it also brought out the best. R20;White and colored worked side by side then,R21; recalls one survivor from Louisiana. R20;Had we the cooperation between races today that we had during that epidemic it would be a blessing.R21;2844 [3276] The U.S. Homeland Security Council National Strategy for Pandemic Influenza is relying on this goodwill: R20;Institutions in danger of becoming overwhelmed will rely on the voluntarism and sense of civic and humanitarian duty of ordinary Americans.R21;2845 [3277] A month after the World War I armistice, the German bacteriologist famous for inventing the test for syphilis wrote from Berlin: R20;For me there are no Germans, no EnglishmenR12;only men who suffer and must be helped.R21; As the fateful year wound down, a Greek daily summed up the evolving spirit of the times with the line: R20;Today all nations sneeze as one.R21;2846 [3278] (c) BirdFluBook.com | Home [3279] | Website by Lantern Media [3280] Bird Flu - R20;In the absence of a pandemic, almost any preparation will smack of alarmism, but if a pandemic does break out, nothing that has been done will be enough.R21; BirdFluBook.com [3281] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3282] R20;In the absence of a pandemic, almost any preparation will smack of alarmism, but if a pandemic does break out, nothing that has been done will be enough.R21; R12;Tony Abbott, Australian Minister for Health2847 [3283] What should we do when the whole world gets sick? R20;From my perspective,R21; Osterholm has said, R20;we pray, plan, and practice.R21; R20;We have to plan as if this will happen tonight.R21;2848 [3284] Pandemic planning needs to be on the agenda of every institution, including every school board, every food distributor, every mortuary, every town hall, and every legislature.2849 [3285] The corporate world seems to be the first to have awakened to the threat. Corporations from Boeing to Microsoft to Starbucks have started mobilizing continuity plans,2850 [3286] though details have been considered R20;privileged company information.R21;2851 [3287] Microsoft did reportedly distribute bottles of hand sanitizers to all of its 63,000 employees worldwide.2852 [3288] The national U.S. preparedness plan still remains to be employed across the country. Both Osterholm and Frist2853 [3289] use the example of the Manhattan ProjectR12;the U.S. governmentR17;s all-out drive to develop the atomic bomb during World War IIR12;to describe the intensity of initiative required to ready the nation in time.2854 [3290] The paradox of a pandemic is that it is worldwide, but intensely local. Nobody is R20;outsideR21; the pandemic to send help.2855 [3291] R20;Communities, in large part, will be on their own,R21; predicts the executive director of the National Association of County and City Health Officials.2856 [3292] The same may be said of individuals. The president of the College of General Practitioners laid out the bottom line: R20;Self-management and self-reliance will be the cornerstone.R21;2857 [3293] Every family must draft and implement its own plan and discuss that plan with friends.2858 [3294] Every organization one is affiliated withR12;schools, clubs, work, places of worshipR12;must be pushed to initiate its own plans.2859 [3295] R20;We must hang together,R21; Ben Franklin is attributed as saying, R20;or assuredly we shall all hang separately.R21; Health and Human Services Secretary Leavitt has criticized Americans for not preparing sufficiently. R20;People have not exercised adequate personal preparedness,R21; he said, R20;to last more than three or four days in their normal environment without going to the store.R21;2860 [3296] According to WHO risk communication experts, these grave public warnings are useful on four different levels. First, people will hopefully take responsibility for preparing themselves logistically. Second, they may help spur their communities into greater preparedness. Third, people may be more supportive of their governmentsR17; planning efforts, and, fourth, when the pandemic begins, the advance notice will have given people time to get used to the idea emotionally, feel less panicky, and take a more active role in protecting themselves, their families, and their communities.2861 [3297] Why havenR17;t we heard more from public officials urging individuals to prepare for what experts declare is a coming pandemic? One reason is that officials do not want to panic the populace. R20;What IR17;ve found is that, behind the scenes, many public health officials are distancing themselves from this global-health-crisis rhetoric,R21; says a former chief medical officer of Ontario. R20;ItR17;s not like terrifying someone about smoking or HIV, where youR17;re actually asking them to do something about it.R21;2862 [3298] R20;Scaring people about avian influenza accomplishes nothing,R21; he says, because weR17;re not asking people to do anything about it.R21; The mistake doesnR17;t lie in scaring people, though; it is in failing to realize and communicate just how much the public can do right now to prepare.2863 [3299] R20;How Scared Should We Be?R21; asked the title of a Time magazine story on bird flu. The subtitle answered: R20;Scared Enough to Take Action.R21;2864 [3300] We can immediately start getting into the habit of practicing proper hand hygiene and respiratory etiquette. We can, as some risk management specialists have recommended, call our doctors to ask for prescriptions of Tamiflu or Relenza and fill the prescriptions before drugstores run out.2865 [3301] We can prepare our familyR17;s pandemic preparedness kit. The kit would contain everything one might need to stay at home for a period that could last from days to months with or without running water and electricity.2866 [3302] EveryoneR17;s checklist will differ based on individualized family needs, but one can start the list by writing down what necessities are used as they come up on a day-to-day basis.2867 [3303] The New Zealand government has taken the additional step of including in the back of all the nationR17;s phone books a list of instructions as to what to do when the pandemic strikes and items to stock in oneR17;s R20;B-ready kit.R21;2868 [3304] In a remarkable speech at a conference in Wyoming, Health and Human Services Secretary Leavitt said, When you go to the store and buy three cans of tuna fish, buy a fourth and put it under the bed. When you go to the store to buy some milk, pick up a box of powdered milk. Put it under the bed. When you do that for a period of four to six months, you are going to have a couple of weeks of food, and thatR17;s what weR17;re talking about.2869 [3305] Though critics dismissed his comments as a bit fishyR12;comparing it to R20;duck and coverR21; during a nuclear attack2870 [3306] R12;he was at least on the right track. Shortly afterwards, the Department of Health and Human Services released guidelines for a more varied menu. After all, R20;Powdered milk and tuna?R21; Jay Leno quipped. R20;How many would rather have the bird flu?R21;2871 [3307] Launched late in 2005, the official U.S. government website pandemicflu.gov [3308] has morphed into quite a useful resource for those who have access to the internet, listing downloadable pandemic planning checklists and guides for schools [3309] , businesses [3310] , and community groups [3311] . The preparedness guidelines for individuals and families [3312] focuses on the stockpiling of food, water and essential supplies. The family food checklist focuses on nutritious staples that can be stored without refrigeration and eaten without cooking, such as ready-to-eat canned goods.2872 [3313] Other possibilities include instant packaged mixes like instant oatmeal, mashed potatoes, and cup soups (though these require water that may be in limited supply), as well as shelf-stable aseptic packaged soups and juices. ThereR17;s even a cookbook outR12;Apocalypse Chow [3314] R12;a humorous yet serious attempt at palatable R20;pantry cuisine,R21; using jarred, canned, and freeze-dried foods.2873 [3315] How much food is enough? Anthony Fauci, the National Institutes of HealthR17;s infectious disease chief, recommends stockpiling R20;a few weeksR17; worth of water, a few weeksR17; worth of non-spoilable foods.R21;2874 [3316] Osterholm told Oprah, R20;Everyone should have enough food today so that they could basically be in their homes for four or five weeksR30;.R21;2875 [3317] Expert Webster has a three-month store of food and water in his home.2876 [3318] Some have recommended locating a rural refuge, if possible, to ride out the storm away from population centers and any ensuing civil unrest. If people have a R20;house in the hills,R21; Webster urges, R20;then go for it--and stay there for three months. And have enough food there already so you can stay as far away from your neighbors as possible.R21;3173 [3319] Rural states like Vermont expect their populations to as much as double to accommodate urban refugees. Vermont officials have reserved freezer space from Ben and JerryR17;s to store overflow corpses.2877 [3320] Food and water might also be more easily obtained in the countryside.2878 [3321] FEMA recommends a gallon of water per person per day,2879 [3322] with additional allowances for any household pets. According to FEMA, one can disinfect water (sourced from a freshwater stream or lake) by keeping it at a rolling boil for a full minute or, if unable to boil it, by using water-purifying tablets found in camping stores or using bleach: Recipe for Water Purification 1 quart (liter) of clear water 10 drops of unscented liquid household chlorine bleach Mix well and let stand for 30 minutes before drinking. Double the amount of bleach for cloudy or colored water, or water that is extremely cold. The water should have a slight chlorine odor after purification. If not, repeat dosage of bleach and let stand an additional 15 minutes. If the chlorine taste is too strong, try pouring the treated water back and forth from one clean container to another several times.2880 [3323] The Boy Scout motto, R20;Be prepared,R21; begged the question, R20;Be prepared for what?R21; The founder of the Scouts replied, R20;Why, any old thing.R21;2881 [3324] With another pandemic inevitable, the best we can do is mediate the consequences. This means doing our best to avoid falling ill, developing contingency plans to survive the infection, and making all necessary preparations to endure social chaos. R20;The objective of pandemic preparedness can only be damage control,R21; said top WHO flu expert Klaus Stohr. R20;There will be death and destruction.R21;2882 [3325] (c) BirdFluBook.com | Home [3326] | Website by Lantern Media [3327] Bird Flu - Trojan Duck BirdFluBook.com [3328] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3329] Trojan Duck Pandemics may be inevitable, but the emergence of Ebola-like superstrains may be preventable. As porous as U.S. biosecurity is, the American system offers some distinct advantages.2883 [3330] Avian influenza tests are provided free of charge by the USDA to the poultry industry, so more than a million tests have been carried out every year.2884 [3331] ThatR17;s a small percentage of the 9 billion birds slaughtered annually for human consumption in the country,2885 [3332] but is probably the best national surveillance in the world.2886 [3333] Many poultry-raising countries cannot afford to test millions of birds, and, as a result, low-path viruses can asymptomatically seed themselves undetected far and wide before additional mutations may make the disease hard to miss.2887 [3334] Confinement systems can also make the systematic culling of infected populations easier once the disease is found.2888 [3335] More and more countries are moving toward killing entire flocks infected with any H5 or H7 virusesR12;low-grade or notR12;to prevent the viruses from mutating into highly pathogenic strains, R20;but this is only feasible,R21; experts assert, R20;if there is financial support from local or national governments.R21;2889 [3336] This is another example of the industry attempting to externalize its costs by having the public subsidize its cleanup: The public bears the cost, and the risk. With public assistance, though, countries with industrialized poultry production have historically been able to stop bird flu. In a country like the United States it may spread into a few hundred farmsR12;even across a few statesR12;but by killing enough birds, the virus has been stopped, whether in Pennsylvania in the 1980s or Virginia in more recent years. Costly, perhaps, but to date effective. This has led some to naďvely advocate that poultry farming worldwide be restricted to large-scale factory farms where infected birds can be R20;rapidly identified and culled,R21;2890 [3337] but industrial systems also have the opposite effect. When a virus hits an industrial facility, it hits big. R20;Once high density industrial poultry areas become affected infection can explosively spread within the units,R21; the Food and Agriculture Organization of the United Nations writes, R20;and the very high quantities of virus produced may be easily carried to other units, to humans, and into the environment.R21;2891 [3338] The U.S. Geological Survey agrees: R20;Infected fowl can become virus pumps producing and shedding large quantities of infectious virus that contaminate the local environment, facilitating transmission of the virus within the population, which also increases the probability of virus spreading to sites/farms beyond the location of the original outbreak.R21;2892 [3339] Industrial poultry production can act as an amplifier for the virus, speeding its spread, making biosecurity next to impossible, and overwhelming tracing and culling capacities.2893 [3340] R20;Clearly, eradication efforts are more successful,R21; OIE experts have written, R20;if there is no massive spread into the industrial circuits of intensively reared poultry.R21;2894 [3341] During the 2003 H7N7 outbreak in the Netherlands, even with the Dutch Army assisting in the culling and disposal of 30 million birds, the virus still managed to slip into two other countries and expose hundreds of people to the virus, some of whom then went home and gave it to their families.2895 [3342] As the WHO points out, despite modern facilities in an industrialized country with a well-developed agricultural and veterinary infrastructure the elimination of the infection in poultry was R20;a complex, difficult, and costly undertaking.R21;2896 [3343] Still, though, the infection was eliminated. To continue to keep the price of chicken meat as low as possible, why not move all of the worldR17;s chickens onto factory farms and simply ramp up surveillance? Annual distribution of 45 billion or so testing kits for each bird slaughtered worldwide may seem cost-prohibitive, but may be cheaper than breeding birds with functional immune systems and raising them at a modest stocking density in a sufficiently clean, ventilated, and low-stress environment. In the hypothetical scenario in which the global flock has been effectively Tysonized, the individual intensive confinement facilities may remain potential breeding grounds for highly pathogenic strains, but the virus would presumably be caught early enough to limit its spread. With enough resources and enough killing, the industry has shown historically that any virus could be stamped out. History changed, though, with H5N1. No one imagined that a killer influenza virus might be able to reinfect its natural hosts without killing them; no one thought a bird flu virus could have it both ways. In its natural waterfowl reservoir, influenza is a frequent flier. As a low-grade virus, it is flown around the world in the guts of migratory birds. In domestic poultry, the virus can grow deadly, but what it gains in virulence it loses in mobility. As one poultry veterinarian put it, R20;Dead birds donR17;t fly far.R21;2897 [3344] Any bird flu virus that grew deadly was presumed to sacrifice its power of flight, enabling industry to effectively mobilize against it. The z+ strain of H5N1 showed that the industry presumed wrong.2898 [3345] Initially wild birds were victimsR12;not vectorsR12;of H5N1. In 2002, H5N1 started killing off waterfowl in Hong KongR17;s nature parks.2899 [3346] Thousands of bar-headed geese perished in ChinaR12;up to 10% of the worldR17;s population of the species.2900 [3347] Professor Shortridge speculated that H5N1 might be capable of R20;ecocide,R21; wrecking the ecosystem by killing off wild bird species, creating a kind of global Silent Spring.2901 [3348] But by early 2004, the virus was showing a trend of decreased pathogenicity in ducks, while remaining highly pathogenic in chickens and children.2902 [3349] Forced into land-based poultry, H5N1 turned ferocious. When it next encountered waterfowl, the virus was devastating. But H5N1 gradually acquired the worst of both worlds, retaining its ability to harmlessly infect globe-trotting waterfowl while continuing to kill poultry and people.2903 [3350] H5N1 no longer has to start from scratch. It was caught early enough once, in Hong Kong, and destroyed. Its re-emergence in 2001 is thought to have been an independent event. Once it attained the unprecedented2904 [3351] ability to jump back into waterfowl from poultry, though, it could become endemic in the worldR17;s wild bird population.2905 [3352] This not only enables the virus to spread around the world and make it virtually impossible to eradicate, it allows for the continual ratcheting up of mutations without disruption. R20;We cannot contain this thing anymore,R21; Webster told the Los Angeles Times. R20;Nature is in control.R21;2906 [3353] Now that we know what bird flu viruses are capable of, we can no longer pretend that we can keep them locked up. They may come into a factory farm on a boot as a low-path virus, but they may escape on a boot, or in a mouse, or on a fly, as a high-path virus. During the Pennsylvania outbreak, H5N2 was found in more than 100 wild birds and rodents in the affected area.2907 [3354] No longer is just the neighboring farm at risk. Now we know that viruses with presumed pandemic potential can escape into the global ecosystem. With that in mind, we must focus on preventing the birth of these viruses in the first place. Both Vietnam and Thailand2908 [3355] have taken steps to restrict or ban duck and goose farming, but this may be too little, too late.2909 [3356] Domesticated ducks are presumably more likely to transmit the virus to chickens, given their greater proximity and the continued existence of viral melting pots like live poultry markets and live animal transports. However, ending their domestication would not be expected to eliminate the risk entirely, given the presence of wild waterfowl overhead. Still, the two billion domesticated ducks farmed by people in East Asia are two billion more experimental hosts than we need allow these viruses.2910 [3357] The earth will be bombarded with influenza virus as long as there are wild waterfowl. The viruses almost always start out harmless, though. They only seem to grow dangerous once they hit poultryR12;and seem only to grow really dangerous in modern-day industrial poultry farms. (c) BirdFluBook.com | Home [3358] | Website by Lantern Media [3359] Bird Flu - One Stray Spark BirdFluBook.com [3360] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3361] One Stray Spark The FAO traces the evolution of a pandemic Minnesota, the R20;land of 10,000 lakes,R21;2911 [3362] is the largest brooding area for aquatic birds in the United States. More wild waterfowl hatch there every year than anywhere else in the country.2912 [3363] In addition, itR17;s a central flyway for migratory waterfowl flying south from Canada in the fall.2913 [3364] Minnesota also happens to be the nationR17;s number-one turkey-producing state.2914 [3365] That combination gave the state the dubious distinction of the avian influenza R20;capital of the world.R21;2915 [3366] No wild turkey has ever been found infected with bird flu in Minnesota or elsewhere.2916 [3367] Land-based birds, such as turkeys and chickens, are aberrant hosts for the virus.2917 [3368] Only when confined in unnatural concentrations does it appear that they can support viral spread that requires close contact. As was shown in pigs, laboratory bird flu transmission studies on turkeys have concluded that R20;transmission rate is markedly reduced when birds are not confined closely.R21;2918 [3369] In industrial confinement, each turkey is typically each allotted only three square feet of living space.2919 [3370] In the wild, turkeys may range over several square miles a day.2920 [3371] They naturally congregate in flocks of 10 to 20.2921 [3372] Typical confinement facilities house 15,000 turkeys per shed,2922 [3373] and those penned outdoors reach flock sizes of 100,000.2923 [3374] With so many animalsR12;albeit outdoorsR12;crowded together under skies with so many ducks, scientists have counted more than 100 separate introductions of low-grade bird flu viruses into commercial Minnesota turkey flocks since the 1970s.2924 [3375] Yet, even with outdoor flock sizes as large as 100,000 birds, in the sun and open air, not a single one of these viruses mutated into a highly pathogenic strain. High-path viruses have never been known to arise in outdoor chicken or turkey flocks.2925 [3376] With tens of millions of ducks2926 [3377] excreting tens of billions of viruses, itR17;s inevitable that outdoor turkey flocks will be caught in the fly-by crossfire. But because they are not intensively confined in the damp, poorly ventilated, and unsanitary sheds, the viruses canR17;t seem to mutate into highly pathogenic forms. The free-range turkeys rarely suffer serious illness. Even if the low-path viruses donR17;t cause sympsoms, though, the bodies of the infected turkeys mobilize resources to knock out the virus, which can result in slower weight gain or reduced egg laying, both of which present a R20;serious economic burden to turkey producers.R21;2927 [3378] So, starting in the late 1990s, Minnesota turkey farmers followed CanadaR17;s example and converted their free-range or R20;semi-intensiveR21; farms to industrial confinement operations. As in Canada,2928 [3379] the number of avian influenza infections dropped dramatically.2929 [3380] This may have saved the industry money in the short term, but the bill for its shortsightedness may soon fall due. Dave Halvorson is an animal scientist and avian health specialist at the University of Minnesota. In a Poultry Digest review, R20;Avian Influenza Control in Minnesota,R21; Halvorson wrote, R20;If exposed to avian influenza, those range turkeys donR17;t usually suffer ill effects. But a nonpathogenic influenza virus, when it gets into a confinement situation, causes severe economic loss in morbidity, mortality and body weight loss.R21;2930 [3381] A highly pathogenic virus born of confinement may pose a human health threat as well. In Monster at Our Door, Mike Davis proposes an analogy for the roles played by indoor and outdoor poultry. R20;In an epidemiological sense,R21; he wrote, R20;the outdoor flocks are the fuse, and the dense factory populations, the explosive charge.R21;2931 [3382] Birds raised outside undoubtedly have a greater exposure to aquatic birds and their viruses,2932 [3383] but the buck seems to stops there. If there were only outdoor birds, influenza viruses would rarely have the opportunity to turn highly pathogenic.2933 [3384] The co-existence of free-range flocks alongside intensive confinement operations, though, allows for the lit fuse to cause damage. Potential mixing at live poultry markets or via contaminated equipment or clothing could transmit low-grade viruses into confinement facilities, and an epidemic may explode. What the turkey farmers have been trying to do is get rid of the fuses. By eliminating outdoor production, they hope to eliminate the possibility that some neighboring producer might track some free-range manure into their local feed store. By confining turkeys indoors, there may be fewer fusesR12;but there is much more to detonate. With that much TNT lying around, all it takes is a spark. In the three years following the Minnesota decision to move all of the free-range turkeys indooors, more than 25 flocks still came up positive for bird flu.2934 [3385] Biosecurity is never absolute. A low-grade strain of H5N1 was even found in a 28,000-bird turkey flock across Lake Superior in Michigan in 20022935 [3386] R12;a year before its Asian cousin H5N1 renewed killing people in Hong Kong.2936 [3387] Since turkeys may be more susceptible to infection than chickens,2937 [3388] the world is fortunate that turkeys are, as of yet, not raised commercially in China.2938 [3389] The bird flu viruses discovered in U.S. turkey sheds were detected in the low-path stage, but had they not been caught in time, some of them might have mutated into widespread killers. The Food and Agriculture Organization of the United Nations understands that the probability of low-grade infection is higher for outdoor flocks, particularly those not R20;cooped up and fenced in,R21;2939 [3390] but that the potential detrimental impact of infection within industrial operations is greater.2940 [3391] The FAO elaborates in its FAQ, Questions and Answers on Avian Influenza: [C]hicken to chicken spread, particularly where assisted by intensive husbandry conditions, promotes the virus to shift (adaptation) to more severe type (highly pathogenic type) of infectionR30;. Intensive production conditions favour rapid spread of infection within units and R20;hotting-upR21; of virus from low pathogenicity to a highly pathogenic types.2941 [3392] In the FAO diagram above, the evolution of a pandemic is traced, starting with R20;Increased demand for poultry productsR21; and ending with a bird flu virus capable of human-to-human transmission.2942 [3393] Minnesota turkeys have been getting fewer sniffles indoors, but turkey producers may be tempting fate. All it takes is a stray sparkR12;a footprint of duck dropping carried in by a ratR12;and the situation could explode. Just as bullets seem to find their way into unloaded guns in the household, influenza viruses littered across the countryside seem to find ways into R20;biosecureR21; sheds warehousing birds. The industry might do better to disarm completely. To prevent the future emergence of exceptionally deadly viruses like H5N1, the global poultry industry may need to reverse its course of rushing toward greater intensification. What should poultry producers do right now, though, given that a virus like H5N1 has already been born and is evidently winging its away across Europe? The question remains unanswered, according to veterinarian Karen Becker, senior health adviser within the U.S. Department of Health and Human Services public health emergency preparedness division.2943 [3394] Some countries like the Netherlands have placed temporary roofing over outdoor poultry yards on migration routes;2944 [3395] others have taken the controversial step of forcing all poultry flocks indoors.2945 [3396] Ironically, a subsequent outbreak of duck plague in Germany was blamed on the R20;severe stressesR21; associated with confining free-range flocks.3187 [3397] The organic lobby in Europe has been most vocal in resisting moves to lock outdoor flocks inside. The Soil Association, the U.K.R17;s leading organic certifier, argues that disease outbreaks should instead be R20;minimized by the avoidance of dense stocking level or intensive housing and the promotion of positive animal health through good husbandry and free-range conditions.R21;2946 [3398] ItR17;s true that keeping birds in smaller numbers and densities with access to clean pasture may provide a boost to the birdsR17; natural immune systems, but, presumably because of prior intensive production in Asia, half of the world is now facing a unique situation in which an avian influenza virus that has already become highly pathogenic could rain from the sky. H5N1 is not done mutating, though. z+ H5N1 is not a pandemic virus. It would still need to change in order to acquire easy human-to-human transmissibility. That final series of mutations is less likely to happen in someoneR17;s backyard flock of ten birds. Put H5N1 in a 20,000-chicken shed floored with feces, though, and H5N1 might rapidly ratchet up adaptations to the R20;human-likeR21; epithelium lining the chickenR17;s respiratory tract and be greatly amplified to further spill back out into the environment. While free-grazing ducks on flooded rice fields in countries like Thailand may be contributing to the spread of H5N1 through water contamination,2947 [3399] bringing pasture-raised poultry indoors in Europe may do more harm than good, confining millions more birds in conditions that may most effectively mutate the virus further. Presumably the only way to significantly slow H5N1 at this late stage is to stop repopulating the sheds. Meat chickens reach slaughter weight so quickly that if breeders stopped breeding and sending chicks out from the hatcheries, every broiler shed in Europe would be vacant in a matter of weeks. That would mean five billion fewer opportunities this year for H5N1 to mutate. Instead we keep reloading. Perry Kendall is chief medical officer of health for British Columbia and co-chair of the Pan-Canadian Public Health Network.2948 [3400] He was there during the 2004 Canadian outbreak, which currently stands as the worse outbreak in North American history, leading to the destruction of 19 million birds. He witnessed that birds kept indoors were more vulnerable than those kept outdoors. R20;YouR17;ve got 10,000 birds all in a small shed, packed in togetherR12;they act like a Petri dish,R21; Kendall explained in an interview. R20;The intensely farmed birds tend to be very genetically similar. The methods of farming result in them being actually more frail and more vulnerable to diseases, particularly since there are so many of them in such a small volume (space).R21; He noted how easy it remains for farm staff to trample virus indoors or for a tractor to spread it from farm to farm. R20;You need to ramp up your biosecurity level to what you see in a laboratory,R21; he said, R20;if you really want to keep infections out of the barns.R21;2949 [3401] (c) BirdFluBook.com | Home [3402] | Website by Lantern Media [3403] Bird Flu - Biosafety Level Zero BirdFluBook.com [3404] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3405] Biosafety Level Zero Biosafety level 3 H5N1 is considered a Biosafety Level 3+ pathogen.2950 [3406] This means that in a laboratory setting, the virus is only to be handled in unique high-containment buildings specially engineered with air locks, controlled access corridors, and double-door entries. Access is limited to competent personnel with extensive training,2951 [3407] and showering is required upon every entry and exit.2952 [3408] Air flow is ducted unidirectional single-pass filtered exhaust only.2953 [3409] All floors, walls, and ceilings are waterproofed and sealed with continuous cove moldings.2954 [3410] All wall penetrationsR12;electrical outlets, phone lines, and the likeR12;are caulked, collared, or sealed to prevent any leaks.2955 [3411] Surfaces are disinfected on a daily basis.2956 [3412] Solid wastes are incinerated.2957 [3413] The industrial poultry industry, in contrast, may be breeding the same virus at essentially a biosafety level of zero. The intensive global poultry industry is not only playing with fire with no way to put it out, it is fanning the flames. And firewalls to contain the virus donR17;t exist. R20;Unfortunately,R21; leading USDA poultry virologist Dennis Senne told an international gathering of bird flu scientists, R20;that level of biosecurity does not exist in U.S. poultry production and I doubt that it exists in other parts of the world.R21;2958 [3414] Further efforts can and should be made to educate poultry producers worldwide about the critical importance of biosecurity measures, but the industry is no longer only gambling with its own fate, but the fate of us all. Even after 17 million birds died as a result of the 1980s Pennsylvania outbreak, one poultry veterinarian wrote, R20;We must face the reality that the Egg Industry will not change its direction because of the threat of AI [avian influenza]. Industries in general change because of economic considerations.R21;2959 [3415] Given taxpayer subsidies for dealing with epidemic disease, the poultry industry may just factor outbreaks into the bottom line. The biosecurity measures that are practiced are better than nothing, but may not be enough to stake millions of lives upon for the sake of cheaper chicken. A pandemic of H5N1, or a comparable future bird flu, may have the capacity to spark the greatest human catastrophe of all time. It may be wiser to move away from intensive poultry production altogether or, at the very least, stop encouraging its movement into the developing world. Massive commercial-scale poultry plants are increasingly appearing in Thailand, southern China, Singapore, Hong Kong, Taiwan,2960 [3416] Brazil, and India.2961 [3417] Though they may rival the size of those in Arkansas, they may lag even further behind in hygienic standards2962 [3418] and biosecurity.2963 [3419] As sloppy as U.S. biosecurity has been shown to be, warehousing live birds by the millions in countries that lack comparative surveillance and control combines the worst of both worldsR12;the intensive confinement of the west with the impoverished infrastructure of the east and global south. Exporting our intensive production model to the developing world is a recipe for disaster. The Food and Agriculture Organization of the UN notes that R20;there seems to be an acceleration of the human influenza problems over the last few decades, involving an increasing number of species, and this is expected to largely relate to intensification of the poultry (and possibly pig) productionR30;.R21;2964 [3420] The domestication of poultry in Asia dates back thousands of years. Live poultry markets have an extensive history in the region. What happened to bring about H5N1? At a November 2005 Council on Foreign Relations Conference on the Global Threat of Pandemic Influenza, the senior correspondent of NewsHour with Jim Lehrer asked that question to the R20;godfather of flu research,R21;2965 [3421] Robert Webster: SUAREZ: Was there something qualitatively different about this last decade that made it possible for this disease to do something that it either hasnR17;t done beforeR30;a change in conditions that suddenly lit a match to the tinder? WEBSTER: [F]arming practices have changed. Previously, we had backyard poultry. I grew up on a farm in New Zealand. We had a few backyard chickens and ducks. The next-door neighbor was so far away it didnR17;t matter. Now we put millions of chickens into a chicken factory next door to a pig factory, and this virus has the opportunity to get into one of these chicken factories and make billions and billions of these mutations continuously. And so what weR17;ve changed is the way we raise animals and our interaction with those animals. And so the virus is changing in those animals and now finding its way back out of those animals into the wild birds. ThatR17;s whatR17;s changed.2966 [3422] In China, the FAO observes, R30;a major and recent event is the very fast change in production structure. This shift in production structure, from mainly rural, to peri-urban intensive and industrial production to supply the urban demand, involves production units with different intensification level (from backyard poultry to industrial) settled in a common environment. This creates ideal conditions for virus emergenceR30;.2967 [3423] Finally, the millennia-old fuses have occasion to ignite. Professor Shortridge illustrates the emergence of H5N1 in a flow chart:2968 [3424] One in seven people in the worldR12;some 900 million peopleR12;live on small farms in China where ducks and chickens and pigs are commonly found. As long as domestication continues in China and elsewhere, pandemics will presumably continue to intermittently arise.2969 [3425] But H5N1 is like no flu virus anyone has ever seen. World War I may have showed us what the virus could become if it caught millions in the trenches; H5N1 may show us what happens when it catches billions. Drawing on his 37 years of experience within the industry, Ken Rudd concluded his trade publication article, R20;Poultry Reality Check Needed,R21; with these prophetic words: Now is the time to decide. We can go on with business as usual, hoping for the best as we charge headlong toward lower costs. Or we can begin making the prudent moves needed to restore a balance between economics and long-range avian health. We can pay now or we can pay later. But it should be known and it must be said, one way or another we will pay.2970 [3426] (c) BirdFluBook.com | Home [3427] | Website by Lantern Media [3428] Bird Flu - Snowflakes to an Avalanche BirdFluBook.com [3429] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3430] Snowflakes to an Avalanche Outbreaks of highly pathogenic avian influenza Heralded by the U.S. Secretary of AgricultureR17;s famous injunction at the time to R20;get big or get out,R21;2971 [3431] industrial poultry production began in the 1950s,2972 [3432] the same decade that fowl plague was discovered to be avian influenza.2973 [3433] As the industry intensified, so did the outbreaks.2974 [3434] There was one outbreak of highly pathogenic bird flu in the 1950s, two in the 1960s, three in the 1970s, three in the 1980s, jumping to nine in the 1990s, and then eight between 2001 and 2004, before H5N1 started its global march.2975 [3435] ,2976 [3436] Now, with the spread of H5N1, the number of outbreaks in the first few years of the 21st century have already exceeded the total number of outbreaks recorded for the entire 20th century. One leading Italian flu scientist told Science, R20;WeR17;ve gone from a few snowflakes to an avalanche.R21;2977 [3437] Highly pathogenic bird flu is hard to miss, as it tends to wipe out entire flocks. In the past 50 years, it has gone from an exceedingly rare disease in poultry to one that now crops up every year.2982 [3438] This dramatic increase in regularity2983 [3439] is matched by an upsurge in the scale of bird flu outbreaks. The majority of the 20th-century outbreaks were limited in their geographic spreadR12;some confined to a single farm or flock.2984 [3440] In all, approximately 20 million birds were affected in the latter half of the century, compared to some 200 million birds in the last few years alone.2985 [3441] In addition to H5N1 in Asia, there was the highly pathogenic outbreak in the Netherlands in 2003 leading to the deaths of 30 million birds,2986 [3442] and the outbreak in Canada in 2004 that effectively killed 19 million.2987 [3443] The director of the Center for Public Health Preparedness and Research at Emory University and other experts2988 [3444] ,2989 [3445] ,2990 [3446] ,2991 [3447] ,2992 [3448] blame the intensification of the disease on the intensification of the industry. R20;We used to have chickens that ran around on a small farm,R21; the director said. R20;There didnR17;t use to be this dense crowding of animals.R21;2993 [3449] According to the latest global statistics, the three most common animals slaughtered in the world are pigs, ducks, and chickensR12;not a good combination from a pandemic perspective. In 2003, more than 1 billion pigs, 2 billion ducks, and 45 billion chickens were slaughtered. Although the preceding five years saw a decline in the number of rodents slaughtered for their flesh (down to 65 million), the single greatest increase in slaughter was ducks, up 30%, along with about 20% increases for the numbers of chickens and geese killed for food. China led the world in land-based animal slaughter, exceeding ten billion animals a year.2994 [3450] When the last pandemic virus arose in China in 1968, there were 5 million pigs in the country and 12 million birds raised as poultry. Now there are 500 million pigs and more than 12 billion birds, a 100,000% increase.2995 [3451] Combined with more than a billion people, R20;Darwin could not have created a more efficient re-assortment laboratory if he tried,R21; remarked Osterholm.2996 [3452] Similar changes have happened throughout southeast Asia,2997 [3453] the hub of the global Livestock Revolution.2998 [3454] In the past ten years Chinese meat production has grown by more than 50%.2999 [3455] To fill the growing demand for meat, Chinese poultry facilities raise up to 5 million chickens at a time,3000 [3456] and industrial pig units confine as many as 250,000 pigs in six-story concrete buildings.3001 [3457] R20;As soon as you have that many animals in one spot,R21; said the UN director of Animal Production and Health, R20;you are likely to get into trouble with disease.R21;3002 [3458] A study published in the Bulletin of the World Health Organization reported five different strains of influenza circulating in chickens in Hong Kong and China as far back as 1982.3003 [3459] Why did it take until 1997 for bird flu to go on the rampage? A professor of virology at University College in London answers, R20;WeR17;ve had nothing like this gigantic chicken breeding in the world before.R21;3004 [3460] Chicken has become the fastest-growing meat sector in the world.3005 [3461] Between 1990 and 1997, the developing world saw an 85% increase in the millions of tons of poultry produced.3006 [3462] In Asia, raising chickens stopped being just a backyard activity. Since its start in the late 1980s, poultry production has more than tripled in Thailand, Vietnam, and Indonesia, and doubled in China.3007 [3463] By 1997, China had more than 60,000 broiler chicken facilities, each confining more than 10,000 birds. A dozen egg farms in Thailand produce about two-thirds of the countryR17;s egg market by caging more than a million hens each.3008 [3464] R20;One of the things weR17;re very worried about in todayR17;s situation versus 1918,R21; Osterholm said, speaking on a Council on Foreign Relations panel, R20;is that, in fact, we have so many new hosts available, that virus can transmit between those billions and billions of chickens in one year more so today than it used to be able to do in a whole century.R21;3009 [3465] The head of the Asian office of the World Health Organization blames the emergence of viruses like H5N1 in part on our R20;[o]ver-consumption of animal products.R21;3010 [3466] As recently as ten years ago, a Chinese family would slaughter a chicken only on special occasions. Now they can afford a chicken every week and soon may be able to afford to eat chicken every day. R20;This means weR17;re hastening the probability of the emergence of a truly lethal flu strain,R21; said Council on Foreign Relations senior fellow Garrett in an interview.3011 [3467] Clearly, the majority of the worldR17;s pork and poultry is now produced on large-scale industrial animal factories,3012 [3468] with further intensification predicted for the foreseeable future.3013 [3469] In China, per-capita meat consumption is expected to increase an additional 45% by 20203014 [3470] with the Chinese population rising continuously until 2030.3015 [3471] Already by the turn of the century, ChinaR17;s fast-food industry had a $24-billion turnover with the market sector growing 20% annually. McDonaldR17;s has 400 restaurants in China; Kentucky Fried Chicken has 681.3016 [3472] H5N1 has further accelerated the intensification of the industry, recently forcing into bankruptcy as many as 90% of smaller Asian poultry producers, who lacked the reserve to stomach a loss of markets for months at a time.3017 [3473] Giant U.S. chicken corporations like Tyson and Perdue can afford expensive control measures and have rapidly expanded into China.3018 [3474] Cargill, a U.S.-based transnational corporation with annual sales exceeding $60 billion,3019 [3475] eradicated, at its own expense, all bird species, including wild ducks, in and around the poultry facilities it owned or contracted across 22 Chinese provinces.3020 [3476] With only the larger corporate producers left standing, the greater number of birds in intensive confinement may provide fertile fodder for viruses like H5N1 to gain greater virulence. R20;We are offering this virus every opportunity,R21; Osterholm said. R20;Every day is an evolutionary experiment going on in Asia, every minute, every second.R21;3021 [3477] (c) BirdFluBook.com | Home [3478] | Website by Lantern Media [3479] Bird Flu - Worst of Both Worlds BirdFluBook.com [3480] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3481] Worst of Both Worlds Evolutionary jackpot Increasing outbreaks among chickens over the past decade have seemed to go hand-in-hand with increasing human transmissibility in both high- and low-grade bird flu viruses. A decade ago, human infection with bird flu was almost unheard of. Now, H5N1 is just one of five chicken viruses that have jumped the species barrier to people. H9N2 infected children in China in 1999 and 2003; H7N2 was found infecting persons in New York and Virginia in 2002 and 2003; and H7N3 infected poultry workers in Canada in 2004.3022 [3482] After H5N1, though, the largest outbreak of bird flu in history was the 2003 disaster in the Netherlands. One of the most densely populated countries in the world, the Netherlands squeezes 16 million people, 11 million pigs, and more than 90 million poultry3023 [3483] into a country no more than twice the size of New Jersey.3024 [3484] Little surprise, then, that such conditions fostered the bird flu epidemic that led to the deaths of an unprecedented (at the time) 30 million birds.3025 [3485] A shocking government report released the following year revealed that the outbreak of H7N7 in the Netherlands had not only infected more than 1,000 people,3026 [3486] but the virus had passed from human to human. Symptomatic poultry workers passed the virus to a R20;whoppingR21; 59% of their household family members.3027 [3487] Fortunately, only one person diedR12;a veterinarian involved in the cull.3028 [3488] It was a relatively wimpy virus, typically causing, at most, mild flu symptoms. Dutch experts realize, though, how close their poultry industry came to potentially preempting H5N1 by sparking the next human pandemic. According to experts from the countryR17;s National Institute of Public Health, Although we launched a large and costly outbreak investigation (using a combination of pandemic and bioterrorism preparedness protocols), and despite decisions being made very quickly, a sobering conclusion is that by the time full prophylactic measures were reinforcedR30;more than 1,000 people from all over the Netherlands and from abroad had been exposed. Therefore if a variant with more effective spreading capabilities had arisen, containment would have been very difficult.3029 [3489] Bird flu viruses previously required freak lab accidents to directly infect people; now this occurs with frightening and increasing regularity. There was an almost 80-year lag between the time when a wholly avian flu virus seemed to grow fatal in 1918 and when a bird flu virus acquired enough virulence to kill again in Hong Kong in 1997. Although industrial poultry production was invented in the 1950s, only within the last few decades has intensive production truly gone global. Shortridge concluded in the academic text Avian Influenza: Prevention and Control: R20;The intensification of the poultry industry worldwide seems to be a key element in causing influenza viruses of aquatic origin to undergo R16;more rapidR17; adaptation to land-based poultryR30;.R21;3030 [3490] We have dug WWI-type trenches for billions of birds all around the world. With unprecedented numbers of chickens intensively confined at record density,3031 [3491] we are seeing bird flu viruses adapt to humans in ways weR17;ve never seen before. The reason the 1918 virus killed fewer than 5% of its victims may have been because it was essentially restricted to the lungs. The spitting of blood and blackening of limbs was a result of the slow-motion drowning the virus triggered by choking the lungs with fluid. For H5N1, R20;ItR17;s worse than that,R21; says Osterholm. R20;[I]t it also goes in and begins to shut down all your vital organs. ItR17;s a domino effect. Your kidneys go down, then your liver goes down, you have all this destruction through necrosis of your lungs and your internal organs. Everything goes.R21;3032 [3492] Never before has a bird flu virus learned to activate itself throughout the human body until H5N1.3033 [3493] By adapting to chickens, bird flu viruses hit an evolutionary jackpot. And by adapting to chickens, the viruses may be adapting to the human raceR12;another multibillion-host bonanza for the virus.3034 [3494] But there need not be billions of chickens. We donR17;t need to keep restocking broiler and layer sheds. No scientist is naďve enough to think that humans will stop eating poultry or eggs in the near termR12;even if the worst-case scenario is one day realized, KFCs may very well be rebuilt with the rest of human civilization. Until, perhaps, the day chicken flesh can be safely grown economically in a lab,3035 [3495] humanity may continue to face influenza pandemics. Ending chicken consumption may be little more than a hypothetical, but ending the riskiest practices, the most intensive forms of industrial poultry production, seems an attainable goal. With the emergence of H5N1, the fate and future of chickens is inexorably tied up with our own. The disease resistance of chickens may need to be considered a critical public health issue. No longer may chicken breeding remain a simple business decision of counting carcasses and seeing if the per-bird profits of the survivors compensate for the mortality. It may be a matter of global health how the industry breeds birds, or whether they should be breeding them at all. Humanity may decide that eating chicken is worth weathering the occasional pandemic, but is cheaper chicken worth risking viruses like H5N1? The best that free-range poultry seem able to pull off appears to be the 1918 2.5% mortality, and it may have needed World War I as an accomplice to do it. As hard as it is to imagine a virus more ominous than H5N1, intensive poultry production on a global scale is a relatively new phenomenon. As poultry consumption continues to soar in the developing world, there is no biological reason that bird flu could not evolve and mutate into an even deadlier niche. All pandemic precursor strains continue to exist in the natural waterfowl reservoir, lying in wait for an opportunity to break out.3036 [3496] As the New York Times put it, R20;Somewhere, in skies or fields or kitchens, the molecules of the next pandemic wait.R21;3037 [3497] H5N1 showed that chickens can breed a flu virus of unparalleled human lethality, and the Dutch H7N7 outbreak showed that chickens can produce a virus that directly jumps from human to human.3038 [3498] Even if H5N1 never develops the capacity to go pandemic, it may only be a matter of time before the new poultry factories of the world breed the deadliest of combinations. (c) BirdFluBook.com | Home [3499] | Website by Lantern Media [3500] Bird Flu - R20;Extreme remedies are most appropriate for extreme diseases.R21; BirdFluBook.com [3501] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3502] R20;Extreme remedies are most appropriate for extreme diseases.R21; R12;Hippocrates3039 [3503] The chief of virology at Hong KongR17;s Queen Mary Hospital believes that R20;the cause and solution [of H5N1] lies within the poultry industry.R21;3040 [3504] The diagram to the right, from the U.S. Department of the InteriorR17;s August 2005 report on the bird flu threat,3041 [3505] illustrates the key role domestic poultry play in the development of pandemic influenza.3042 [3506] All influenza viruses start in waterfowl, but there does not seem to be direct spread from the natural duck reservoir directly to mammals or humans; domesticated fowl are required as the stepping stone. The most a wild duck virus seems to be able to do to a person is cause a mild case of pinkeye.3043 [3507] The scientists who unsuccessfully tried to infect human volunteers with wild duck viruses in the lab even tried passing the virus from one person to the next to enhance human infectivity. They squirted a million infectious doses up the first personR17;s nose, then inoculated a second person with the first personR17;s mucus, and continued down the line. Despite the high doses used and five person-to-person passages, the virus still could not grab hold. A study published in 2006 in Clinical Infectious Diseases found that pig farmers are up to 35 times more likely to show evidence of swine flu exposure than those with no occupational contact with pigs,3044 [3508] but studies of Canadian wildlife personnel have consistently found them negative for waterfowl virus infection.3045 [3509] Although one duck hunter and a few wildlife professionals tested in Iowa showed evidence of exposure to wild bird viruses,3169 [3510] influenza viruses found in their natural undisturbed state do not seem to pose a human threat. Maybe if duck viruses could squeeze 20,000 humans into one big elevator they might be able to get somewhere. Getting 20,000 chickens together in an enclosed space is not only easy, it happens all the time, allowing for millions of passages of viruses through cells and susceptible hosts who have nowhere to run. In this way, the virus can be amplified3046 [3511] and perhaps adapt to humans by proxy. Thanks to that evolutionary quirk of natureR12;the certain molecular resemblance of the respiratory tract of a chicken to our ownR12;as the virus gets better and better at infecting and killing chickens, it may be getting better and better at infecting and killing us. According to a senior molecular virologist at the University of Cambridge, R20;Chickens provide a bridge between the wild bird population where avian influenza thrives and humans where new pandemic strains can emerge. Removing that bridge will dramatically reduce the risk posed by avian viruses to humans.R21;3047 [3512] If domestication of poultry is the bridge,3048 [3513] itR17;s a bridge that can be burned. The domestication and captivity of birds have created biohazards like Salmonella, Campylobacter, Psitticosis (parrot fever), and avian tuberculosis. Most seriously, it brought us influenza. R20;Like most aspects of what is normally celebrated as progress, the domestication of animals had a downside,R21; wrote one Massachusetts Institute of Technology professor of history.3049 [3514] Pandemics of influenza may be one such downside. If the development of animal agriculture marked the R20;start of the era of zoonosis,R21; as the dean of Michigan StateR17;s veterinary school asserts, then the scaling back of animal agricultural production may hasten its end.3050 [3515] In hopes of severing the link from the viral reservoir, there are those at the FAO who have suggested that domestic duck farming be abolished.3051 [3516] Ducks were domesticated 150 generations ago,3052 [3517] ,3053 [3518] a blink in human evolution.3054 [3519] While ending the domestication of ducks would not alleviate the current crisis, since H5N1 has already flown the coop, it may help prevent future pandemics.3055 [3520] R20;Prevention of H5N1 avian influenza in humans is best achieved by controlling infection in poultry,R21; advises the WHO.305 [3521] As noted by the dashed lines in the Department of the InteriorR17;s diagram, though, not only has H5N1 jumped directly from chickens to humans, it has pulled off one of its greatest tricks yetR12;a homecoming of sortsR12;reinfecting waterfowl. By retaining its lethality for chickens and humans while remaining relatively harmless for migratory birds, the Z mutant of H5N1 has created a monster, enabling the presumably factory-farmed virus to wing itself around the world. At this stage, the prospect of eradication seems remote.3057 [3522] A leading flu authority at Mount Sinai School of Medicine once remarked that if you eliminated the ducks in the world, youR17;d essentially eliminate pandemic influenza.3058 [3523] R20;But you canR17;t kill all the ducks and aquatic birds of the worldR12;that would be absurd,R21; says Webster. R20;It makes you realize that influenza is a noneradicable disease.R21;3059 [3524] The influenza virus itself, as it exists in nature, may be R20;noneradicable,R21; but we donR17;t care what happens naturally inside the guts of wild ducksR12;and the ducks donR17;t seem to either. ItR17;s the human pandemic variety we want to get rid of, which may be possible if we remove the stepping stones by which the virus hops from the rice paddies of Asia to children hop-scotching in Europe. According to the U.S. Geological Survey, R20;Currently there is no evidence that humans have been affected with H5N1 influenza virus through contact with wild birds. All reported human infections have been associated with contact with domestic poultry.R21;3060 [3525] In theory, then, the solution to preventing future pandemics, and maybe even stopping the potentially impending pandemic in mid-flight, is to kill all the chickens. H5N1 has been stopped before. R20;It was fairly obvious,R21; Shortridge said, recounting Hong Kong in 1997, R20;the chickens had to go.R21;3061 [3526] And it workedR12;killing all the chickens in the territory eliminated the virus. Genetic analyses of the H5N1 strain that arose four years later show that it emerged independently, jumping again from the natural duck reservoir to chickens. Hong Kong tried killing all the chickens once again, but it was too late. Leading scientists advocated ridding the entire territory of chicken farms, banning imports, and closing down poultry markets, but H5N1 had already escaped.3062 [3527] Dutch virologist Jan de Jong, to whose lab the defining human Hong Kong virus was originally sent, scoffs at the limited culling of hundreds of millions of chickens as too little too late. R20;These measures are really nonsense,R21; he said in a telephone interview. de Jong suggested that a near-total culling of AsiaR17;s poultry and the curtailment of poultry farming for several years would be the only way to stop the H5N1 outbreaks.3063 [3528] Osterholm seems to agree. R20;So even though we talk about having killed off 300 million chickens in trying to reduce it,R21; he said, R20;we turn over billions of chickens a year in China just for food supply. Each one of those that are born and hatched are brand new incubators for the virus, too, so we keep resupplying this susceptible population, we keep allowing this.R21;3064 [3529] H5N1 keeps taking shots at sustained human-to-human transmission; by repopulating the global poultry flock we keep reloading the gun. Both scientists realize, presumably, the economic implications that make such a solution a political impossibility. Given H5N1R17;s spread to Europe, the mammoth slaughter would have to extend far beyond Asia, and because the same underlying conditions of emergence would remain, the cessation of poultry production would have to remain indefinitely. R20;As long as the kettle is on the fire, the water temperature will continue to rise until it reaches the boiling point,R21; the World Health OrganizationR17;s representative in Thailand explained. R20;The pandemic threat will not go away because we donR17;t have a way to put out the fire yet.R21;3065 [3530] Yes, but we could remove the kettle. Let the flame of influenza continue to flicker in wild waterfowl, but we could, in theory, remove the middleman kettle of poultry production in hopes of preventing influenza from boiling over into the human population. The logical extension of the effective 1997 Hong Kong strategy is to kill off the entire worldR17;s chicken flock. Lest this sound too extreme, thatR17;s already what happens to most of the worldR17;s broiler chickens every six weeks or so. Meat-type chickens have been bred to grow at such accelerated speed that the global broiler flock is essentially slaughtered every handful of weeks and replaced with hatchling chicks. Logistically, killing off all commercial chickens in the world is easyR12;we have them all locked up. The slaughtering apparatus is in place and already undergoes trial runs about every month or two. If, instead of restocking, humanity raised and ate one last global batch of chickens, the viral link between ducks and humans might be severed, and the pandemic cycle could theoretically be broken for good. Maybe bird flu could be grounded. The Centers for Disease Control and Prevention understands the human health risks of the R20;ongoing intensification and consolidation of the food-animal industry,R21; but acknowledges the protein demands of a growing global population. The deputy director of the CDCR17;s Office of Global Health described the dilemma simply as R20;we want more protein while not jeopardizing human health.R21; However, only a trivial percentage of the worldR17;s calories (1%) and protein (3%) come from poultry.3066 [3531] ,3077 [3532] Technically, there is no human nutritional need for any animal protein. In fact, according to the Harvard University School of Medicine, the healthiest sources of protein are R20;beans, nuts, grains and other vegetable sources of protein.R21;3068 [3533] One reason India is not considered a high-risk area for novel influenza strains is reportedly that a large portion of the population is vegetarian.3069 [3534] Regardless, from a pandemic standpoint, it doesnR17;t matter whether one switches to beans or to beef; what matters is breaking the feathered link in the chain. Smallpox could be eradicated because there is no contemporary nonhuman animal reservoir. Unlike influenza, in which human beings are considered R20;irrelevant for the virusesR17; survival,R21;3070 [3535] the smallpox virus only existed in humans and so could be vaccinated out of existence since there was no source of new genetic material.3071 [3536] It is no coincidence that 11 out of the top 12 most dangerous bioterrorism agents are zoonotic pathogens.3072 [3537] How else can you infect millions unless you pull something out of the animal worldR12;a rabbit out of the hat, but in reverse? The human immune system would therefore have no prior exposure, and the infection could slip beneath the bodyR17;s radar. By cutting influenzaR17;s genetic supply lines to the animal world, no more pandemics would presumably be possible. What would happen to human influenza if its relationship to the avian reservoir were severed? People would still get the flu, but our bodies would be hip to it. The virus would continue its genetic drift, accumulating mutations in its outer coat so as not to be utterly routed, but no longer would there be fresh virus to swap genes with. In other words, no more viral sex. Eventually, without continued intrusions of restless alien viruses backed into new evolutionary corners, along with the presumed extinction of pandemics, we might even expect seasonal influenza to lose virulence gradually with time as it achieved more of a balance. According to Webster, itR17;s been this R20;irregular infusion of avian virus genes into the human virus gene poolR21; that has prevented human influenza viruses from R20;reaching an evolutionary equilibrium with their hosts.R21;3073 [3538] The evidence is as easy as learning influenzaR17;s ABCs. There are three types of human influenza viruses: A, B and C. Influenza A is considered the only type of influenza that can cause pandemics, because influenza A is the only type of influenza with an active link to the animal world. The influenza viruses ever bubbling forth from waterfowl are influenza A viruses that may cross over and establish themselves within poultry and pigs and people. Influenza B and C viruses are thought to have originally arisen the same way as influenza A viruses (from waterfowl, centuries ago), but theyR17;ve circulated and adapted to the human race for so longR12;hundreds or even thousands of yearsR12;that they can no longer reassort with avian viruses.3074 [3539] TheyR17;ve evolved into new species in the biological sense that they can no longer reproduce with their ancestral progenitors to create viable offspring. They are now strictly human viruses; the avian umbilical cord has been cut.3075 [3540] As such, influenza B and C viruses are old hat to humanityR17;s collective immunity. They never cause pandemics and, in general, result in milder disease. Influenza C has presumably parted ways with its avian ancestors to such an extent that it rarely causes clinical disease at all.3076 [3541] If influenza C viruses manage to cause any symptoms, the infection more closely resembles the common cold than the flu.3077 [3542] And that is what we might expect all human influenza viruses to evolve toward in a pandemic-free world cut off from the avian reservoir.3078 [3543] Without chickens, the worst that may bubble up from that viral volcano is a rare case of pinkeye resulting from sweeping duck manure or forgetting to turn our heads should sneezing seals not properly cover their mouths. Instead of letting the worldR17;s chicken flock vanish, canR17;t they all be vaccinated? As we know from our own flu shots, which have to be reformulated every year, the influenza virus may be too slippery to be stopped by vaccination because of its high rate of mutation. Vaccination can keep birds superficially healthy, but may not stop the replication and excretion of the virus.3079 [3544] While vaccinated birds may not get sick (so profitability is not diminished), chicken sheds may remain breeding grounds for superflu viruses.3080 [3545] In fact, vaccination may even select for more virulent mutants. Webster is particularly concerned about ChinaR17;s plan to vaccinate its 14 billion-strong poultry flock.3081 [3546] R20;[P]athogens can evolve to more virulent pathotypes in vaccinated herds or flocks,R21; reads one virology textbook, R20;especially when animals are held under intensive production systems.R21;3082 [3547] As long as there is poultry, there will be pandemics. It may be us or them. One consequence of the evolutionary stability of the waterfowl reservoir is that the pandemic precursors will always be waiting in the wings.3083 [3548] Influenza viruses mutate at the same rate in wild ducks as in any other species. These duck viruses have over millions of years reached peak fitness such that any net change in any direction makes new mutants a little less perfect and they are selected against and nudged out of the applicant pool. The mutant swarm in aquatic birds is always correcting itself. Viral mutants continue to arise that may be just a little better at infecting chickens and humans, but are quickly outmaneuvered by the duck optimal variant. As soon as that swarm of viruses is forced into a new environment, though, any mutants for which a growth advantage exists may be quickly selected. The pandemic potential of the virus has existed, and continues to exist, ready to blast off if given the opportunity. Our role is to try to keep it in the ducks and not provide the virus an enormous lab of feathered subjects to tinker in. Noting the emergence of zoonotic diseases in general is largely a product of human activity, FAO researchers conclude that R20;the solution to these problems is also a matter of human choice.R21;3084 [3549] (c) BirdFluBook.com | Home [3550] | Website by Lantern Media [3551] Bird Flu - R20;The modern world worships the gods of speed and quantity, and of the quick and easy profit, and out of this idolatry monstrous evils have arisen.R21; BirdFluBook.com [3552] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3553] R20;The modern world worships the gods of speed and quantity, and of the quick and easy profit, and out of this idolatry monstrous evils have arisen.R21; R12;Rachel Carson, author of Silent Spring3175 [3554] Site of Triangle of Doom coverup If poultry were raised only in small outdoor flocks, influenza viruses might be robbed of the opportunity to evolve into highly pathogenic strains, but given the existence of industrial operations, small-scale farmers need to take precautions. A major 2004 USDA report on biosecurity among backyard flocks across the country found the same neglect for even basic biosecurity measures. Only about half of gamefowl operations (which tend to raise cockfighting birds) were recorded as following biosecurity fundamentals such as proper attention to potentially contaminated footwear.3085 [3555] Safety measures like disinfecting water supplies3086 [3556] or netting the ponds found on the properties of more than one-third of U.S. small poultry operations3087 [3557] to discourage wild waterfowl, would add additional security.3088 [3558] Some practices in Asia, like the integrated aquaculture feeding of animalsR17; wastes and the common custom of feeding gutted chicken viscera back to the flocks, should be strongly discouraged.3089 [3559] Although there are measures large-scale operations could take to mediate some of the risk in minor waysR12;enriching environments in swine operations with straw bedding, for example3090 [3560] R12;industrial production carries intrinsic dangers. A textbook on the control of avian viruses laid out the inherent contradiction between intensive confinement and healthy flocks: R20;The potential for a virus to be transmitted among a group of birds can be reduced by preventing overcrowding, providing maximum separation between birds, providing frequent exposure to sunlight and ensuring a constant supply of fresh air. Sunlight will destroy many viruses that are free in the environment.R21;3091 [3561] To reduce the emergence of viruses like H5N1, humanity must shift toward raising poultry in smaller flocks, under less stressful, less crowded, and more hygienic conditions, with outdoor access, no use of human antivirals, and with an end to the practice of breeding for growth or unnatural egg production at the expense of immunity. This would also be expected to reduce rates of increasingly antibiotic-resistant pathogens such as Salmonella,3092 [3562] the number-one food-borne killer in the United States. We need to move away from the industryR17;s fire-fighting approach to infectious disease to a more proactive preventive health approach that makes birds less susceptibleR12;even resilientR12;to disease in the first place.3093 [3563] In light of viruses like H5N1, more and more experts are questioning the sustainability of intensive poultry production. UN Animal Health Officer Peter Roeder, responsible for viral diseases at the FAO,3094 [3564] was asked, R20;Could a more sustainable livestock production reduce the risk of such diseases?R21; Roeder answered: This is certainly soR30;. [T]he vulnerability to epidemic diseases of intensive, industrialized livestock farming systems is increasingly being demonstrated. This brings into doubt the viability of these systems. A high human population density in close contact with several species of intensively farmed livestock potentially provides a substrate for cross-species transmission, evolution and amplification of many pathogenic agents.3095 [3565] R20;The drive to gain extra production should not be at the expense of dire and abnormal consequences,R21; says Peter Collignon, director of infectious diseases and microbiology at AustraliaR17;s Canberra Hospital. He adds, There are a whole lot of practices in animal husbandry that means we have got large numbers of animals all close together with practices to give often a very short-term gain that may not be sustainable in the long term, but may well have long-term consequences that are not known, or not thought through at the time.3096 [3566] University of Philippines College of Medicine professor Romeo Quijano also judges H5N1 to be a manifestation of the inherent contradictions of industrial poultry production. R20;The recent outbreak of avian flu and its spread to humans in several countries,R21; he said, R20;should be taken as a serious warning signal of the devastating effects of an unsustainable, environment destructive, and profit-oriented food production system.R21;3097 [3567] New Zealand government food safety advisor Meriel Watts declares: Governments should take heed of this latest food crisis and outlaw the rearing of chickens in overcrowded factory farms. Chickens can be sustainably reared in free-range, organic systems that dramatically improves the health of the birds, and consequently also dramatically reduces the risk to human healthR30;. Cramming tens of thousands of birds into cramped sheds is a human health disaster in waiting.3098 [3568] The poultry industry disagrees. The president of the WorldR17;s Poultry Science Association from Hong Kong declared that R20;it does not make sense to get rid of the poultry industry to get rid of the bird flu. That would be an ignorant act.R21;3099 [3569] FAO experts have expressed concern that the strong industrial poultry sector might interfere with bird flu control efforts in general, perhaps even R20;hijack the agenda.R21;3100 [3570] The industry bristles at the suggestion that intensive confinement causes undue stress. R20;Confinement rearing has its precedents,R21; the National Live Stock and Meat Board wrote in its publication, Facts from the Meat Board. R20;Schools are examples of R16;confinement rearingR17; of children which, if handled properly, are effective.R21;3101 [3571] One agribusiness foundation wrote R20;Most veal calves are kept in individual stalls similar to a babyR17;s crib.R21;3102 [3572] The industry knows how vulnerable it is to public scrutiny. Industry proponents try to deflect criticism by dismissing critiques as city-slicker ignorance.3103 [3573] At the same time, they admit that truly informed consumers are the last thing they need. R20;One of the best things modern animal agriculture has going for it is that most peopleR30;havenR17;t a clue how animals are raised and processed,R21; wrote the editor of the Journal of Animal Science in an animal agriculture textbook. If most urban meat-eaters were to visit an industrial broiler house, to see how the birds are raised, and could see the birds being R20;harvestedR21; and then being R20;processedR21; in a poultry processing plant, some, perhaps many of them, would swear off eating chicken and perhaps all meat. For modern animal agriculture, the less the consumer knows about whatR17;s happening before the meat hits the plate, the better.3104 [3574] This industry attitude of concealment extends to bird flu. Industry reaction to the 2002 outbreak of H6N2 in poultry in Southern California is instructive. A study published by the National Institute of Medicine gives the background: Millions of birds shedding viruses traveling in trucks easily spread the infection to farms along the route. That is when the Turlock region, which is bound by three major roads, became known as the Triangle of Doom: a bird couldnR17;t enter the region without becoming infected with H6N2. Tens of millions of birds in California became infected with this H6N2 virus during a four-month period beginning in March 2002.3105 [3575] The industry covered it up. Corporate producers used their own veterinarians and did not release the diagnosesR12;not to the state, not to neighboring states, not to the World Organization for Animal Health, and not even to neighboring farms, even though the information might have let them better protect their flocks. According to the 2005 National Institute of Medicine report, The Threat of Pandemic Influenza: Are We Ready?, the emergence of the R20;Triangle of DoomR21; was kept quiet R20;by corporate decision-makers who feared that consumer demand would plummet if the public knew they were buying infected meat and eggs.R21;3106 [3576] As with the SARS outbreak in China the following year, economic interests trumped public health.3107 [3577] Public relations concerns extend to questioning research directions. At a 2004 avian influenza symposium, when a medical epidemiologist and pediatrician in the Influenza Branch at the CDC insisted that further studies on H7N3 viruses in the U.S. poultry industry needed to be done, a poultry representative seemed more concerned about the industryR17;s public appearance. Eric Gonder, a spokesperson for the National Turkey Federation, for the North Carolina Poultry Federation, and for one of the nationR17;s largest pig producers3108 [3578] (all at the same time),3109 [3579] responded, R20;How would you suggest we conduct these studies without getting into a negative perception of agriculture?R21;3110 [3580] Europe is taking the lead in opposition to the trend of intensification in animal agriculture. David Byrne is the European Commissioner for Health and Consumer Protection. R20;Let me say a final word on animal rearing practices,R21; he said at a Public Health Risks from Emerging Zoonotic Diseases conference in 2004: In the agricultural sector, greater account needs to be taken of the implications of intensive animal husbandry practices. Public health policy needs to have a much greater role to ensure human health protection. Policies need to encourage a shift away from intensive rearing and to ensure the adequacy of risk management measures at farm and production unit level. These are issues that we also need to pursue at international level.3111 [3581] The vice president of the European ParliamentR17;s Environment Committee said in a press release, Factory farming and global transportation are behind the breeding and spreading of diseases like avian influenza. The EU must act now to prevent further outbreaks of such diseases. Measures must be taken to regionalize production, reduce transport distances, and impose animal welfare standards so that European factory farming is phased out in the coming years.3112 [3582] Writes the official French Agency for Food Safety, The never-ending quest for better productivity and profit, the constantly evolving technologies in animal farming and the ever-increasing exchanges in a market now open to the world, might favor exposure to hazards. New and largely unexpected so-called production or R20;man-madeR21; diseases will come along after those we already experience.3113 [3583] The French Food Safety AgencyR17;s Network for the Prevention and Control of Zoonoses, comprised of 16 European partners and more than 300 scientists, focuses blame in part on R20;the growing trade in meat, milk and other animal products.R21;3114 [3584] In reaction to the spate of emerging animal diseases, and to the dismay of the industry,3115 [3585] the Chancellor of Germany has called for an end to factory farming3116 [3586] and R20;a new politics that stands for consumer protection, improved food safety and natural, environmentally-friendly farming.R21;3117 [3587] In 2001, the World Bank made a surprising reversal of its previous commitment to fund large-scale livestock projects in developing nations. In its new livestock strategy, the Bank acknowledged that as the sector grows, R20;there is a significant danger that the poor are being crowded out, the environment eroded, and global food safety and security threatened.R21;3118 [3588] This reflects the multiplicity of issues in addition to zoonotic disease pointed out by R20;factory farmingR21; opponents. Critics have argued that production profitability should not be the sole consideration in animal agriculture,3119 [3589] and, in addition to human and animal health3120 [3590] and welfare,3121 [3591] other factors should be taken into account, such as soil heath,3122 [3592] biodiversity,3123 [3593] climate change,3124 [3594] social justice,3125 [3595] equity,3126 [3596] good governance,3127 [3597] and environmental stewardship.3128 [3598] In the United States, the American Public Health Association (APHA) is among those advocating for R20;radicalR21; (from the Latin radix, for R20;rootR21;3129 [3599] ) change. In 2003, the APHA passed a R20;Precautionary Moratorium on New Concentrated Animal Feed Operations,R21; in which it urged all federal, state, and local authorities to impose an immediate moratorium on the building of new factory farmsR12;including industrial turkey, laying hen, broiler chicken, and duck facilities.3130 [3600] The response has been underwhelming. The only response on a state level that currently exists is a limited moratorium on pig factories in North Carolina, up for renewal in 2007.3131 [3601] The industry claims that intensification is driven by consumer demand for cheap meat.3132 [3602] In response to the lead 2005 New Yorker story on the threat of bird flu, staff writer Michael Specter was asked if, based on his research, we would R20;have to rethink such things as large-scale poultry farming?R21; He replied: Well, I canR17;t imagine a better prescription for killing large numbers of animals with a single disease than packing tens of thousands of them into factory farms where they are lucky if they have 15 inches of personal space. Still, the economic incentives toward factory production of food are hugeR12;we want cheap meat. So itR17;s going to be very difficult to change.3133 [3603] According to one economic analysis, transitioning to slower-growing breeds of broiler chickens with improved immunity might be expected to cost consumers no more than a dollar or two a year.3134 [3604] The proportion of household income Americans spend on food is low compared to other countries, though this may be more a reflection of American wealth than the actual price of U.S. groceries.3135 [3605] And the true cost may not be reflected on the label. According to a team of food policy experts, our current industrial model of animal agriculture R20;may deliver cheap food (defined as food accounting for a reduced proportion of household expenditure) but it has an unfortunate tendency to disguise or add to the environmental [and public] health bill.R21;3136 [3606] Agricultural economists have suggested R20;true costR21; pricing and labeling schemes to educate consumers about their choices in the marketplace.3137 [3607] Lonnie King is the dean of Michigan State UniversityR17;s College of Veterinary Medicine and president of the American Veterinary Epidemiology Society. He is also a member of the National Academy of Sciences and the former administrator of the USDAR17;s Animal and Plant Health Inspection Service.3138 [3608] King was instrumental in creating an advisory panel within the World Organization for Animal Health to address emerging zoonoses.3139 [3609] His talk at the 2004 meeting of the USDA National Agricultural Research, Extension, Education and Economics Advisory Board was titled, R20;Emerging Threats and Opportunities in Animal Agriculture.R21;3140 [3610] King set out to explain the root causes behind the Third Age of human disease, which R20;began about 1975 with the emergence or reemergence of zoonotic diseases.R21; He described the factors leading to the creation of this R20;microbial perfect stormR21; as R20;anthropogenic,R21; meaning human-caused. R20;As climate changes and ecosystems are destroyed, pathogens will become ubiquitous, constantly mixing and mutating to find new animal hosts and new avenues of infection.R21;3141 [3611] King told the USDA Advisory Board that animal agriculture has reached a R20;strategic inflection pointR21; where the R20;old rules and lessons no longer apply.R21; He characterized this paradigm shift as moving from agriculture as R20;a trusted providerR21; to agriculture as R20;a part of the problem.R21; King agreed with the National Research Council and Government Accountability Office reports that advised the USDA to shift its focus away from increased production and toward other priorities, such as environmental sustainability.3142 [3612] Veterinary scientists at the University of Georgia published a 2004 review in the journal Clinics of Laboratory Medicine in which they wrote, R20;Watching the steady stream of new and emerging diseases, one is reminded of the carnival game R16;Whack-a-mole.R17;R21; Instead of just responding to each new crisis as it arises, they proposed a more proactive strategy of addressing the underlying causes of disease emergence.3143 [3613] Council on Foreign RelationsR17; senior fellow for Global Health Garrett concluded, R20;Ultimately, humanity will have to change its perspective on its place in EarthR17;s ecology if the species hopes to stave off or survive the next plague.R21;3144 [3614] (c) BirdFluBook.com | Home [3615] | Website by Lantern Media [3616] Bird Flu - R20;The single biggest threat to manR17;s continued dominance on the planet is a virus.R21; BirdFluBook.com [3617] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3618] R20;The single biggest threat to manR17;s continued dominance on the planet is a virus.R21; R12;Joshua Lederberg, Nobel laureate3145 [3619] Senate Majority Leader Frist describes the recent slew of emerging diseases in almost biblical terms: R20;All of these [new diseases] were advance patrols of a great army that is preparing way out of sight.R21;3146 [3620] Scientists like Joshua Lederberg donR17;t think this is mere rhetoric. He should know. Lederberg won the Nobel Prize in medicine at age 33 for his discoveries in bacterial evolution. Lederberg went on to become president of Rockefeller University. R20;Some people think I am being hysterical,R21; he said, referring to pandemic influenza, R20;but there are catastrophes ahead. We live in evolutionary competition with microbesR12;bacteria and viruses. There is no guarantee that we will be the survivors.R21;3147 [3621] There is a concept in host-parasite evolutionary dynamics called the Red Queen hypothesis, which attempts to describe the unremitting struggle between immune systems and the pathogens against which they fight, each constantly evolving to try to outsmart the other.3148 [3622] The name is taken from Lewis CarrollR17;s Through the Looking Glass in which the Red Queen instructs Alice, R20;Now, here, you see, it takes all the running you can do to keep in the same place.R21;3149 [3623] Because the pathogens keep evolving, our immune systems have to keep adapting as well just to keep up. According to the theory, animals who R20;stop runningR21; go extinct. So far our immune systems have largely retained the upper hand, but the fear is that given the current rate of disease emergence, the human race is losing the race.3150 [3624] In a Scientific American article titled, R20;Will We Survive?,R21; one of the worldR17;s leading immunologists writes: Has the immune system, then, reached its apogee after the few hundred million years it had taken to develop? Can it respond in time to the new evolutionary challenges? These perfectly proper questions lack sure answers because we are in an utterly unprecedented situation [given the number of newly emerging infections].3151 [3625] The research team who wrote Beasts of the Earth conclude, R20;Considering that bacteria, viruses, and protozoa had a more than two-billion-year head start in this war, a victory by recently arrived Homo sapiens would be remarkable.R21;3152 [3626] Lederberg ardently believes that emerging viruses may imperil human society itself. Says NIH medical epidemiologist David Morens, When you look at the relationship between bugs and humans, the more important thing to look at is the bug. When an enterovirus like polio goes through the human gastrointestinal tract in three days, its genome mutates about two percent. That level of mutationR12;two percent of the genomeR12;has taken the human species eight million years to accomplish. So whoR17;s going to adapt to whom? Pitted against that kind of competition, Lederberg concludes that the human evolutionary capacity to keep up R20;may be dismissed as almost totally inconsequential.R21;3153 [3627] To help prevent the evolution of viruses as threatening as H5N1, the least we can do is take away a few billion feathered test tubes in which viruses can experiment, a few billion fewer spins at pandemic roulette. The human species has existed in something like our present form for approximately 200,000 years. R20;Such a long run should itself give us confidence that our species will continue to survive, at least insofar as the microbial world is concerned. Yet such optimism,R21; wrote the Ehrlich prize-winning former chair of zoology at the University College of London, R20;might easily transmute into a tune whistled whilst passing a graveyard.R21;3154 [3628] (c) BirdFluBook.com | Home [3629] | Website by Lantern Media [3630] Bird Flu - In a Flap BirdFluBook.com [3631] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3632] In a Flap Executive editor of Poultry magazine in a 2005 editorial The poultry industry is starting to wake up to the pandemic threat, but seems more concerned about how the disease will affect business. Big Chicken in the United States looked forward to the R20;export market opportunities for U.S. chicken and turkey to replace lost poultry productionR21; due to the global spread of H5N1,3155 [3633] but is worried about what bird flu might mean for poultry consumption in general. A recent article in Poultry International pointed out that R20;[p]reviously known and documented R16;flu pandemicsR30;almost certainly originated in poultry. Because the connection was either not appreciated at the time and/or not widely publicized, there was little or no impact on public confidence in poultry products. The poultry industry,R21; concludes author Terry Mabbett, R20;is unlikely to get off so lucky next time around.R21;3156 [3634] The poultry industry acknowledges that public health implications could be serious, but have other concerns as well. USDA researchers have voiced fear that R20;[i]f this virus [H5N1] were to become established in the human population, it has the additional potential to cross back to chickens from humans and cause a severe influenza outbreak in poultry.R21;3157 [3635] The industry is concerned that if thereR17;s a human H5N1 pandemic it could disseminate the virus over long distances and lead to R20;further infections of poultry.R21;3158 [3636] Some in the industry confess that the R20;emergence of zoonotic infections associated with poultry is a disquieting trendR21;3159 [3637] and internally acknowledge the role of intensive confinement. R20;Modern day poultry production is so highly concentrated that this disease can spread so rapidly,R21; one Maryland chicken farmer admitted. R20;We canR17;t ignore this any longer.R21; Ignorance may be blissfully more cost-effective, though, than change. One anonymous industry official of a major poultry producer was quoted acknowledging the basic principle. R20;ItR17;s like if one person in a crowded room coughs, more people have a chance of getting infected,R21; the official said. R20;But the question is, can there be an equitable way of doing that without affecting business?R21;3160 [3638] The executive editor of Poultry magazine put the trade-off this way in a 2005 editorial: R20;The prospect of a virulent flu to which we have absolutely no resistance is frightening. However, to me, the threat is much greater to the poultry industry. IR17;m not as worried about the U.S. human population dying from bird flu as I am that there will be no chicken to eat.R21;3161 [3639] (c) BirdFluBook.com | Home [3640] | Website by Lantern Media [3641] Bird Flu - The Price We Pay BirdFluBook.com [3642] You are currently viewing the printer-friendly version of this page. Click here to view it as it originally appeared. [3643] The Price We Pay R20;We are the original recyclers,R21; boasted the rendering industry.3162 [3644] Converting billions of pounds of slaughterhouse waste into cheap protein for farm animal feed seemed like a good idea at the time, a profitable idea. The industry got away with it for more than a hundred years.3163 [3645] In the end, though, with the advent of mad cow disease, society realized that it wasnR17;t worth the costs to public health and the industrial practice was banned throughout much of the world. What may be cheaper for industry may be too expensive for humanity. It was the same story with DDT and the growth hormone DES that the poultry industry insisted on using for so many years despite the known cancer risk. Society has determined that certain industries and practices may be too potentially damaging and has successfully scaled them backR12;nuclear power, clear-cutting, strip mining, to name a few. Intensive poultry production is a relatively new phenomenon of the past 50 years. In light of H5N1 and our increasing understanding of the role of poultry in pandemics, with enough political will the industrialization in the poultry sector can be scaled back as well. Senator Frist has warned that H5N1 R20;poses an immense potential threat to American civilization.R21;3164 [3646] Tara OR17;Toole, director of the Center for Biosecurity of the University of Pittsburgh Medical Center, agrees. R20;What we are talking about is not just another health issueR12;it is a nation-busting issue,R21; she added.3165 [3647] This sentiment is expressed worldwide. R20;It will be the worst nightmare,R21; the President of Indonesia said in 2005. R20;This plague can be more dangerous than the tsunami which last year killed hundreds of thousands of people in a matter of minutes.R21;3166 [3648] To help people wrap their heads around what an H5N1 pandemic could be like, Osterholm suggests that people consider the South Asian tsunami, an event that far outshadowed the devastation of hurricane Katrina: R20;Duplicate it in every major urban center and rural community around the planet simultaneously, add in the paralyzing fear and panic of contagion, and we begin to get some sense of the potential of pandemic influenza.R21;3167 [3649] A tsunami in every city, every town, everywhere. People drowning in their own blood. R20;An influenza pandemic of even moderate impact,R21; Osterholm wrote, R20;will result in the biggest single human disaster everR12;far greater than AIDS, 9/11, all wars in the 20th century and the recent tsunami combined. It has the potential to redirect world history as the Black Death redirected European history in the 14th century.R21;3168 [3650] Hopefully, for humanityR17;s sake, the direction world history will take is away from raising birds by the billions under intensive confinement. Tragically, it may take a pandemic with a virus like H5N1 before the world realizes the true cost of cheap chicken. 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