A rchive Date
[ 31-01-2004 ]
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[ International Relations ]
sub-Categoy
[ Canada ]
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[http://chealth.canoe.ca/health_news_detail.asp?news_id=9576
Flu pandemic would wreak social devastation
Provided by: Canadian Press
Written by: HELEN BRANSWELL
Jan. 30, 2004
TORONTO (CP) - Six weeks ago, Fujian flu was top of the newscasts. Three weeks ago, SARS cases in China owned the headlines. Now those stories are yesterday's news, overshadowed by a health threat so ominous even the experts are nervous: Pandemic influenza.
"The potential is so much bigger - and the consequences," infectious disease expert Dr. Donald Low explains.
It's been 35 years since the world experienced a flu pandemic, the Hong Kong flu of 1968-69. And it, by pandemic terms, was a mild one, killing only an estimated one to four million people in the developed world.
So many of us don't have a clue what a flu pandemic would be like. Getting a picture of what it could entail might make it easier to understand why the World Health Organization and governments around the globe are desperate to keep the current avian influenza outbreak from sparking a pandemic among humans.
Let's put it this way: When it comes, it won't be pretty.
"This pandemic is going to have disastrous effects, depending on its infectiousness and severity of disease," Low admits.
Dr. Bryce Larke, medical officer for the Yukon, was one of the few in his class in medical school to stay healthy during the 1957 pandemic but the Hong Kong flu took him out of commission for about three weeks.
Larke isn't convinced the avian flu outbreak will spark a pandemic. But whenever the next one comes, he says, its impact will be enormous.
"I can't think of anything more devastating to the modern world - short of a nuclear holocaust of unbelievable proportions," Larke says, adding the next pandemic will likely travel the world faster than earlier versions.
"While we don't have the troop ships coming home from the first Great War, we've got 747s with recirculating air which is going to be far worse than an open troop ship.
"When it comes, it hits a large number of people in the community at the same time or about the same time. So it's the impact that within a few weeks, it will have laid low many, many - a high percentage - of the population of that community. . . . Things indeed do grind to a halt."
Over the course of months, illness will race round the globe, making untold millions sick. And when it hits an area - a city like Vancouver, say - anywhere from a third or more of the people would be sick at one time.
Drug store shelves will empty. Grocery store shelves may as well, because food distribution networks won't be operating at full steam.
"You get a taste of it with the ice storm (of 1998) and the blackout (of 2003)," says Dr. David Butler-Jones, past president of the Canadian Public Health Association.
"The problem is that it wouldn't be five to 10 days, it would be two to three months or more, perhaps, that you'd have to be dealing with these things."
Butler-Jones is the medical officer for the Sun Country health unit in southern Saskatchewan. That province, like most, has a pandemic preparedness plan which co-ordinates with a minutely detailed federal plan Health Canada has been working on for over a decade.
Larke, who has been involved in the development of the plan, says it covers "every facet that you could imagine."
The problem is, even the best laid plans can only hope to minimize the spread of illness and the social disruption.
Hospitals will be overwhelmed. Maintaining essential services - fire and police departments, power generation, water purification and public transit to name a few - will be an enormous challenge.
"Police and firefighters may not be out in the numbers that they should be. Ambulance drivers and emergency rooms themselves are decimated with sick people. And God bless the nurses - if you haven't got nurses, you haven't got medical care," Larke says.
Work, school, leisure - nothing will be unaffected. Public gatherings may be cancelled. Scared people will likely hunker down at home, trying to avoid unnecessary contact with others.
Businesses will struggle to operate with skeleton staffs.
"At an individual company level, what people need to be braced for is: What happens if 50 per cent of your workforce can't come in to work?" notes Dr. Allison McGeer, an infectious disease specialist at Toronto's Mount Sinai Hospital.
Dr. Bonnie Henry, who leads pandemic planning at Toronto Public Health, has been working with business leaders from the financial sector trying to help them plan for that eventuality. She tells them they have to identify their core functions - the things they absolutely have to do to stay afloat.
"You need to say: 'OK, I need to work on the premise that maybe up to half of my people will be gone. I don't know who they are. But I need to have some plan so that I can fill in with a minimal number of people.'"
You can't assume the pandemic strain will ravage the elderly and spare the young. The 1918-19 Spanish flu - which killed 20-to-50 million people worldwide, took its worst toll on previously healthy people aged 25 to 34.
Most people survive influenza, though they may not return to full health for several weeks after a bout. But pandemic strains can kill with surprising speed. And flu can also trigger secondary infections which are often the cause of flu-related deaths.
Pharmaceutical companies won't be able to meet the demand for anti-viral drugs to fight influenza, McGeer notes, or the antibiotics that could spell the difference between life and death for those who go on to develop pneumonia.
Standard morgues won't be able to handle all the bodies. Henry admits Toronto Public Health is already in the process of contracting to use facilities like arenas as temporary morgues when the next pandemic strikes.
Larke notes that in the infamous Spanish flu outbreak, people's inability to bury their dead in a timely fashion had a hugely demoralizing effect on communities. Gravediggers were too ill to work; supplies of coffins dried up.
Henry expects this will be a problem during the next pandemic as well, noting that Toronto only has the capacity to cremate about six bodies a day at this point.
In 1918, Toronto recorded 1,000 flu deaths in a single month - and the city wasn't one of the hardest hit. Philadelphia recorded 711 flu deaths in one day - in one day! - in October of that year, according to Alfred Crosby's book Epidemic and Peace, 1918.
No one will be untouched by the disruption, the fear, the loss of lives.
"Pandemic influenza is one of the things that I hope will never happen in my lifetime," admits Henry, a veteran of Toronto's SARS battle.
"But I think if you can put together a reasonable approach to what you're going to do, it is going to save lives. And it is going to do your best to prevent extreme chaos."
QUICK FACTS
How do flu pandemics start? It's all about the close interaction of wild birds, domestic fowl, other barnyard animals (sometimes) and humans, most often in parts of rural China.
When a brand new virus which has never before circulated among humans breaks out of nature and passes through this chain, it can acquire the ability to infect millions of vulnerable people around the globe.
Here's a look at the chain:
Wild aquatic birds - Migratory birds like duck and geese seem to be the original reservoir of influenza viruses. They spread the viruses to domestic poultry by mingling among them in crowded barnyards.
Domestic fowl - It used to be thought that chickens, turkeys and other domestic birds played only an intermediate role in the transmission chain, that they could not spread influenza directly to humans. The 1997 outbreak of avian influenza in Hong Kong - 18 people were infected and six died - proved that wasn't true. Direct bird-to-human transmission has occurred in the current avian flu outbreak as well. So far none of these outbreaks have led to human-to-human transmission.
Swine - Before 1997, it was believed pigs played a key role in allowing new influenza strains to acquire the ability to infect humans and pass from human to human. That route still exists, but has been shown not to be the only one.
Despite being one of the most common infectious diseases to afflict mankind, surprisingly little is known about the notoriously unpredictable influenza or why several times a century it turns into a major killer.
Following are some facts about pandemic influenza:
WHAT IS IT? A flu pandemic happens when an influenza virus that hasn't circulated before in humans emerges from nature. No one has immunity and millions around the world get sick.
HOW DOES IT HAPPEN? A pandemic flu strain can be created two ways. An existing strain can mutate; flu viruses are prone to mutation. Or an animal virus can reassort or mate with a human flu virus, acquiring the ability to spread from human to human.
HOW OFTEN DOES IT HAPPEN? On average about three times a century. In the 20th century, pandemics occurred in 1918-19 (the Spanish flu), 1957-57 (the Asian flu) and 1968-69 (the Hong Kong flu).
WHO GETS SICK? In regular years, the very young and very old are hardest hit. But that's not necessarily the case during pandemics. The death toll for the Spanish flu was highest among people aged 25 to 34.
HOW MANY LIVES COULD IT CLAIM? That depends on the severity of the strain. The Spanish flu killed an estimated 20-to-50 million people; the Hong Kong flu, a mild strain, killed between one to four million people in developed countries. The WHO predicts the next pandemic could kill between 280,000 and 650,000 people in the developed world. Health Canada predicts 11,000 to 58,000 deaths in this country if a vaccine cannot be developed.
WILL THERE BE A VACCINE? The WHO, in conjunction with manufacturers like Shire Biologics of Canada, will work feverishly to produce one. But there are no guarantees a vaccine will be available in time to protect large portions of the general public.
 World Fact Book (CIA)]
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