Bird Flu

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History

Plagues have periodically spread across the world killing literally millions of people. There have been three major plagues that raced across the world. One in the 6th, 14th and seventeenth Centuries. The one in the 17th Century was known as the Bubonic Plague 1347-1351. It started in the crowded cities of Europe and was spread by fleas biting infected rats. It lasted for four years and wiped out half of the population of Europe, a total of 137 million people died. The causative organism was the bacteria Bubonic Pestes, a strain that we can easily eradicate with antibiotics today. Most of these people died of pneumonia.

The most recent pandemics (an epidemic that has spread beyond a defined area to become world wide) were those 1918, 1957 and the Hong Kong flu of 1967-68. I will not dwell on the 1967 Hong Kong flu only to tell you that I personally was on R&R during the Viet-Nam conflict when I contracted it from there. I was in a delirious state for three days and my only recollection of those three days was that “I could see blue skies through the white ceiling”.

This 1918 pandemic is thought to have started in China in Guan-dong Province and was caused by the influenza virus. Influenza is mainly a virus of birds which occasionally mutates and becomes infective to animals and humans. Guan-dong Province incidentally is the same area where the SARS virus is thought to have originated along with the recent ‘Bird Flu’. This is an incredibly densely populated area where many of the population breed chickens and small animals in their back yards. This condition therefore makes it ripe for humans to have very close contact with their foul and when the latter become infected it becomes easier for the virus to spread to their owners. Recent evidence obtained from slides of soldiers who died in the 1918 pandemic and from an Alaskan village known as Brevig Mission that was wiped out during that same time has shown that the DNA sequence was entirely from avian origin. That particular virus mutated directly from birds to humans bypassing the usual route of domestic animals (usually pigs).

The 1918 Pandemic is also referred to as the Spanish Flu. This is not because it started there but that because Spain stayed neutral during WW-1 it had a more open and free press that reported on it. Tragically because many combatants and families fled war torn lands the flu hit Spain exceptionally hard, killing over 8 million people. The reports of the world wide death counts of the 1918 pandemic range from 20 to 100 million, however, majority of historians have settled on 40 to 50 million deaths. Whatever the number really was, it was the most virulent and probably the worst pandemic in history. To put it into perspective WW-1 which lasted for four years (1914-1918) killed nine million people and that was a war marked by mustard gas, trench warfare and no antibiotics.

The virus spread throughout the world following the trade routes. In those days shipping was the mainstay of transportation and the earliest cases appeared in the port cities. America reported its first cases in March of 1918, China and Japan reported cases in April and Africa and South America by May. Those populations that did not receive annual infective bouts of influenza were particularly hard hit. In India 22% of the entire Armed Forces and 5 % of the entire population was wiped out, 17 million people. Sixty percent of the Eskimos in Nome Alaska were wiped out and 80-90% of the Samoan population was devastated. In Fiji 14% of the population died within 2 weeks. The death toll in America was mild compared to many counties with ‘only’ 670,000 deaths being reported. The only known place in the world that did not have any reported cases was the island of Marajo at the mouth of the Amazon river in Brazil. Heat kills the virus. In America the government responded by instituting quarantines with little success. Theaters, dance halls, churches and other places of public gathering were ordered closed for a year. Stores were prohibited from holding sales and funerals were limited to 15 minutes. Gauze masks were distributed by the Federal government but with little effect. Many towns formed armed defenses not letting in any strangers. Health care workers, coffin workers, grave diggers and social welfare people died at alarming rates leading to bodies stacking up and people in their homes too sick to care for themselves and too weak to even eat. Many died of dehydration and starvation. To compound things even more most of the medical doctors were away fighting the war. Medical schools were closed and 3rd. and 4th. year medical students manned the wards.

Treatment then was rudimentary by today’s standards. Aspirin had just been invented by the German company Bayer but because of the war many feared that it might be a form of germ/chemical warfare and would not take the anti fever medicine. Cinnamon in powder or oil mixed with milk was usually given for fever. When patients became so short of breath they could hardly breath they gave epinephrine which is used to today to open up the airways of an acute asthmatic attack. Unfortunately the duration of actions is only a few minutes so it was an extremely short reprieve.
The Bird Flu of today is caused by a strain of the virus known as the H5N1. It is extremely virulent and appears to be mutating to a more virulent strain. Today about 50% of the people being infected expire, whereas the 1997 “Bird-Flu” had only a 33% mortality rate. Today it is gaining the scary title of
the “Chicken Ebola Virus”.

Current and Past Viruses

Currently the strains that we usually encounter and those that are covered by our current vaccines are the H1N1( also known as Type A New Caledonia), the H3N2 ( also known as Type A California) and the Type B Victoria and Yamagata. Unfortunately many people erroneously do not take the vaccine because they have memories of the old types of vaccinations that used to bring on a mild case of the flu. These were caused by making the vaccine using ‘whole inactivated viruses’, but today we use only purified surface antigen preparation ( in English we take only the sub-viron particles that are known to be the cause of flu and only those go into the making of the vaccine). This has eliminated most of the old side effects. Today there are currently only two types of vaccine available on the market:

1. The inactivated trivalent vaccine
2. Live attenuated influenza vaccine.

In the 1918 pandemic the age group that had the highest percentage mortality was the 20-40 year olds. But when we look at the national data today on who is getting flu shots the numbers are alarming. For 18-49 year olds only 24% get vaccinated and for 50-64 year olds its 46%. I guess at our age we no longer believe we are invincible. The CDC has been remarkable for predicting which strain will hit us at home. They have been correct 28 out of the last 30 years and when they are right the efficacy of the vaccine is 70-90%. The efficacy is measured by reductions of occurrences of influenza like illnesses, number of episodes, days of work missed, days of illness, health care visits, days on antibiotics, and in days of over-the-counter medicines taken. To me it is quite remarkable that if the vaccine is that effective and then when you look at Dr. Cessarone’s study using cold processed bovine colostrum to think that it is more than three times effective as the vaccine – that says a lot
The H5N1 virus of today is spread from infected birds via their saliva, nasal secretions, and feces. It has spread from domestic husbandry to the wild migratory birds. As of 2005 human cases of the flu have been reported in Cambodia, China, Indonesia, Thailand, Vietnam, Turkey and Iraq.

The above picture of the world indicates that so far the problem areas are mainly Asia and Europe but as you can see Alaska is just a short flight from Kamchatka and it is on the migratory bird pathway. Below is the pattern of migratory ducks in the North American Continent. Several mathematical models and ornithologists have predicted that the Bird Flu will show up in some form in the U.S. during the 2006 migratory cycle.

The problem is that we have never had to have a vaccine for the H5N1 virus and on top of that the virus appears to kill the eggs upon which the virus is made. Recent studies are showing that ducks are shedding more virus for longer periods of time which is allowing the transmission to continue for longer periods of time, hence greater infectivity.

The current method of trying to prevent spread of this virus is to destroy any foul suspected of being infected. The two problems that we see today vs. 1918 are that then they international ports – today we have internal air-ports. Studies show that if someone is infected in an aircraft that after a four hour flight , 72% will be infected. The virus can live forever in freezing temperatures such as the northern most latitudes of Siberia and Alaska. However if it is warmed to the freezing point 32 degrees Fahrenheit or zero degrees Celsius then it can only live for 30 days. Warming it up to body heat 98.6 F. kills the virus in six days, but heating it up to 140 degrees F can kill it in 30 minutes.

The incubational period for humans is 2-17 days.
An April 2006 report released by NIH (National Institute of Health) describes the interregional spread of influenza through the U.S. Their findings were that the spread of the virus is connected with the rates of movement of people going to and from work. The more populated a region was the faster it spread. The study also found that when a virus is introduced into a populated state it spreads faster than say an unpopulated state. Most epidemics tended to spread from California, our most populated state. While the annual flu epidemics take about 5 weeks to spread it is predicted that a pandemic would take 2-4 weeks to spread to every state. Adults were more responsible for the spread than children.

Many people are asking their physician what would it take for this ‘bird flu’ to become a ‘human’ flu and what conditions must happen for a pandemic to start. Firstly, there must be a new influenza sub-type for which humans have no immunity. Secondly it must be able to infect and cause illness in humans and thirdly the virus must be able to be spread from one human to another. The first two criteria have been met. For the third to occur the virus has to mutate either by ‘reassortment’ or ‘adaptive’ mutation. Reassortment can occur almost instantly and very easily, whereas adaptive mutations take a much longer period of time.
Since there are over one billion cats and dogs in the U.S. a frequently asked question is, how susceptible is your pet dog or cat? So far known transmission has occurred in pigs, tigers, domestic cats, ferrets, leopards and weasels. In October 2004 147 0f 441 tigers has to be euthanized in a Thai zoo. The exact amount and numbers will never be known for all of those animals in the wild. As of this writing I am unaware of any domestic dogs being infected.

Symptoms

This section is perhaps the scariest section of all. The presenting symptoms are usually just the same as any regular flu. Fever, sore throat, headache, muscle aches, joint pains, cough and vomiting. This then progresses to shortness of breath followed by severe difficulty in breathing, which then progresses to ARDS (Adult Respiratory Distress Syndrome, otherwise known as Shock Lung) and death. In the latter stages, which if left untreated can only take 6-8 hours to reach, the person dies by suffocation. There is such an overwhelming infection that the virus preferentially attacks the lungs and the victims literally drown to death within hours. Tumor Necrosis Factor responds to the infection and then elevates the temperature to near delirium heights. This then stimulates more cytokines which because of the virulence of the H5N1 virus sets of a ‘cytokine storm’ making the victim feel extremely sick.
There were many stories of a parent going to work feeling well but never returning, dying on the job that day. There is a story of four elderly women who met regularly to play bridge. They began as usual one evening but by morning three of them were dead.
Of all the human cases examined so far the treatment has consisted of Tamiflu, Steroids, I.V. fluids, anti-fever medicines, nutritional and ventilator support but only about 50% have survived. The only two drugs that have helped have been Oseltamivir (Tamiflu) and Zanamivir (Relenza). The older drugs Amantadine (Symmetrel) and Rimantadine (Flumadine) have been found to be ineffective.

Solutions and Planning

Unfortunately many of the countries that are at highest risk have been routinely treating their poultry with anti viral drugs. This has had the consequence of making two of the four anti viral drugs ineffective. In other words resistance has set in and now we only have two drugs that are of any use against the H5N1. The FDA has now proposed a sweeping and protective rule that would inhibit using anti-influenza drugs for any extra-label use. The consequence of this should help prevent resistance from building up here in America.
Should the unthinkable occur, that is, the virus mutates and spreads human to human, what should you do?
I am going to give you a somewhat biased opinion based on the fact that I have experienced the Hong Kong flu directly and I am a physician who knows quite a lot about this potential killer.
1. My first suggestion is to be prepared to stay at home and lock down for as long as three months. That means having enough food, water and cash for three months.
2. Even though the regular flu shot will not be directly effective against the H5N1 virus it will help elevate part of your immune system. Get your flu shot.
3. Having some Tamiflu on hand will also be a good idea.
4. If you need to go outside for brief periods, have a N95 rated face mask.
5. Antibacterial soaps and solutions. Since the virus can be inactivated by acidic solutions have plenty of white vinegar (acetic acid) on board. Iodine and Hibeclens soaps and solutions also kill the virus.
6. Even if you are locked down someone may cut themselves and the last place you want to unnecessarily visit will be the Emergency Room. Have a really good First Aid Kit at home.
7. For those of us that live in Florida we are used to knowing that in any natural emergency we should stock up on batteries, flash lights, propane gas, battery powered radios, candles, matches, mobile generators and enough gas to keep them all going.
8. If you have the time and have a medical condition that requires you to take medicine on a regular basis make sure you have enough.
9. Books, DVDs, board games, playing cards and hobbies will be a necessity to keep your mind working well.
10 But don’t forget about such things as ‘real necessities’. I’m talking about a supply of toilet paper, tooth paste, soap, diapers, coffee, garbage bags and water. It would also be prudent to have the capability to purify or filter the water.
10. Food. There are a lot of things that could be said on this matter and although I am not a Mormon, they because of their belief system, have protocols for storing food that would well be worth looking at. I am sure they have a web site although I am not sure what it is. But from my standpoint you need to have a store of multivitamins, enough protein in the form of canned or frozen meats, fish and beans. You should have an adequate amount of starches in the form of rice, dried potatoes, pasta and beans. Dehydrated and cans of fruits, and vegetables. Cereals in the proper form can also be very nutritious. We all tend to eat differently so the main thing think about is what are your specific food preferences, keeping in mind that which will provide good nutrition for your immune system.
11. Since Dr. Cessarone’s study (page 131) showed that cold processed bovine colostrum was more than three times ‘more’ effective than the flu vaccine I would also strongly suggest that you have a large supply of this on hand.
With a virus so virulent being adequately prepared might be the difference between life and death.