Bird flu, or avian flu,
has been a top story in the news lately, but is the media offering a realistic
portrayal of the problem? In this article, we will explore the avian flu in
the context of influenza outbreaks of past decades and from a chiropractic health
professional’s perspective.
The “Flu”: By the Letter and Other Viruses of Note
The flu is an RNA virus, which is named by using the letters H1 through 16 and
N1 through 9. Any combination of H’s and N’s can surface, which
means there are literally hundreds of possible combinations that could end up
causing the next influenza outbreak. Aside from the simple influenza virus,
several other viruses have made their way into the news in the past decade.
SARS, the West Nile virus, Monkey Pox and Ebola virus all have been concerns
of the world’s public health community and healthcare workers around the
world. We all remember the fear that SARS instilled in travelers, and the airplanes
full of surgical mask-wearing passengers. SARS was fairly tame on the epidemiological
scale, yet was responsible for 8,437 cases and 813 confirmed deaths worldwide.1
From the high level of media coverage one would have guessed that SARS had killed
hundreds of thousands of people!
Influenza: A Historical Look
In 1918, the Spanish flu devastated the world, with anywhere from 20 to 50 million
deaths worldwide. This very virulent strain of the influenza virus (H1N1) took
only five weeks to spread from coast to coast in the United States, and infiltrated
many of the rural and frontier areas that never expected to be affected by this
epidemic. While the flu often selects the elderly and children as victims, this
epidemic indiscriminately killed people of all ages.
In 1957, the Asian flu (H2N2) epidemic left one million people dead worldwide.
While the death toll was only 1/20th as high as the Spanish flu outbreak of
1918, this epidemic was still a significant tragedy. Better knowledge of the
transmission of influenza and advances in hygiene and public health practices
may have reduced the death toll of the Spanish flu epidemic. Later, in 1968,
the Hong Kong flu (H3N2) surfaced, and circled the planet, killing a half million
people. Various strains of this flu are still circulating, causing significant
numbers of death and illness each year.
The Garden Variety Flu
The flu, to most of us, is simply an inconvenience. We feel achy, we may have
to take a day or two off from work, and we gradually get back up and around,
nearly as good as new (and with resistance to that particular flu virus should
it come around again). But, in the larger scheme of things, the flu is still
a significant cause of death. Each year, in the U.S. alone, over 10,000 people
die from the common, garden-variety flu. The vast majority of those deaths are
seen in the elderly and in small children, particularly infants.
What About Bird Flu?
The Avian flu (H5N1) has the potential to cause significant numbers of human
deaths, should it become readily transmissible from human to human. Mike Osterholm,
Ph.D., the director of the Center for Infectious Disease Research and Policy
at the University of Minnesota, is making some bold and ominous predictions
about the bird flu (and since he is an authority on such topics, people are
listening). He predicts that the bird flu may be responsible for one million
deaths in the U.S. alone, and 180 to 360 million deaths worldwide.3 So far,
there have been approximately 135 cases of bird flu globally since 1997, 68
of which resulted in death. With a 50 percent mortality rate, there is cause
for a serious look at bird flu. However, it is important to note that all cases
to date were in people who had direct contact with diseased birds, and the disease
has not spread from human to human.
While some say Osterholm’s estimates may be conservative, others speculate
about reasons that he may aim high. After all, people in such roles would really
like to see the government allocate a large sum of emergency money toward research
on, and work toward, the control or prevention of a bird flu pandemic. Any groundwork
that is done related to studying this strain of flu will surely be valuable
into preparing us for the influenza virus’s inevitable next resurgence;
whether as bird flu or some other strain.
Osterholm, and others in the public health world, have grave concerns that even
if the bird flu begins to take hold overseas, governments may be hesitant to
share such information due to the economic ramifications of a bird flu scare.
This tendency toward non-disclosure is a bane to healthcare workers who need
timely and honest information about emerging epidemics to rapidly mobilize workers
and supplies to protect the public’s health. One need not look far to
see the economic parallels when “mad cow disease” was the top news
story. The beef industry suffered massive losses, much of which resulted from
media hype and a lack of knowledge among the public about the disease. The images
of hundreds of thousands of chickens being incinerated or buried in mass graves
is stunning, and has a real effect on people’s emotions; not to mention
their purchasing and consumption of poultry products. Those who err on the side
of caution (or hysteria) avoided turkey this Thanksgiving, fearing that they
might become the next bird flu casualty. Once again, media hype has contributed
to unexpected numbers of turkeys left unsold in grocer’s freezers; an
unnecessary response in an information void.
Separating Fact From Fiction
Here are some facts that should be shared among our families, friends and patients.4
It is important, when media sensationalism begins to impact even the most rational
people’s decisions, for the chiropractic profession to refrain from consuming
too much pop science. Additionally, they should (as always) direct the public
to sound, evidence-based sources for information on this and other diseases.
Globalization: Instant Epidemics
The concern over bird flu is realistic in countries where people prefer to buy
their poultry live, take it home, and then slaughter and pluck it at home. This
is particularly risky because children and older persons are often given the
task of plucking the birds, potentially exposing the most vulnerable age groups
to the bird flu virus.
If one wants to keep an eye on this flu strain, they should initially keep an
eye on those countries with open bird markets, and potentially poultry workers
in other countries as well. Epidemics, which used to spread with methodical,
predictable patterns, are now wildly unpredictable due to our global connectedness
through air travel.2 In a few hours, diseases can be transported from continent
to continent, making the detective work required by epidemiologist an incredibly
complex challenge. However, if the bird flu is to become a threat to us in the
United States, it will most likely be via imported poultry or other birds.
The Bird Flu: What next?
There is a big push by researchers to create funding pools for the development
of an avian influenza vaccine. The theory is, since the strain of virus responsible
for the bird flu (H5N1) is known, the process should be simple. Even if the
virus mutates slightly, allowing it to be readily transmissible human to human,
it will still be an H5N1. One significant challenge, however, is that the vaccine
development process uses chick embryos (common chicken eggs) for an inexpensive,
quickly developing host for the virus. But, the bird flu virus keeps killing
the embryos in which researchers are trying to develop the virus, and subsequently
the vaccine. This poses a real challenge to vaccine development in the case
of bird flu, one that will likely be expensive to overcome.
So, should we all be standing in lines to get the bird flu vaccine, should one
become available? Not if a person is healthy and not likely to be exposed to
the virus. There is some reason for concern in that if a bird flu vaccine does
get developed, there will be little, if any time to test the long-term effects
of this vaccine on human subjects. The swine flu shot (see resource list for
more information) and the deaths it caused should be a cautionary tale. When
any health intervention is rushed to the market, there is the potential for
risks to go undetected until thousands have been exposed. We all need to push
for the appropriate checks and balances to be in place so that good science
does not fall by the wayside in the presence of profiteering among the pharmaceutical
giants.