Britain prepares for bird flu death toll of thousa

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The Sunday Times - Britain



August 07, 2005

Britain prepares for bird flu death toll of thousands
Jonathon Carr-Brown, Health Correspondent



THE government is to mount an exercise to help emergency services prepare for any potential bird flu pandemic that could kill thousands of people in Britain.
The disease has already jumped species, leading to three human outbreaks, the most serious of which killed 23 out of 34 people infected in Asia last year.



Sir Liam Donaldson, the chief medical officer, has said that the question “is not if the pandemic comes, but when”.

The exercise in September — a table-top simulation in a bunker beneath Whitehall — will be co-ordinated by Cobra, the cabinet civil emergencies committee, and will involve the army, police, health department and other key government organisations.

The aim is to gauge how the country would cope if a mutation of the virus affecting chickens and ducks in Asia were to sweep the human population in a global pandemic.

According to the health department’s contingency plan, the healthcare system could be overwhelmed. Estimates of deaths in the first six weeks of the outbreak range from 20,000 up to 710,000, after which the disease would begin to subside. About 20m people could suffer serious breathing problems.

The young would be hit hardest because older people have some immunity left from the Hong Kong flu pandemic of 1968. Officials are looking for sites for mass mortuaries. The global death toll could make the pandemic more serious than the 1918 Spanish flu outbreak, the worst infection since mass statistics have been gathered.

In Britain the virus killed 228,000 people. Worldwide, about 50m died, more than in the first world war.

If bird flu strikes Asia, international travel would virtually cease and health checks would be carried out at every British sea and airport as the government tried to prevent the infection spreading to the UK.

The health department’s strategy calls for infected people, along with anyone with whom they have come into contact, to be quarantined, although under existing laws this could only be voluntary.

Schools would be closed, large public gatherings banned and travel around the country restricted to essential journeys only.

Patricia Hewitt, the health secretary, announced last month that the government intended to buy up to 3m doses of a vaccine that protects against H5N1, the flu strain currently killing chickens and ducks in Asia.

In the event of an outbreak these doses will be given to health staff, key workers needed to keep the country running, and then people most at risk from infection.

However, if a bird flu pandemic strikes, the virus is likely to be an as yet unknown mutation of H5N1, meaning existing vaccines would offer only partial protection.

The Anatomy of an Infectious Disease in China

Sing Tao Daily, Editorial, Translated by Eugenia Chien, Aug 04, 2005

A pig-borne disease that has infected people in Sichuan is the newest public health emergency in China, following cases of bubonic plague in Qinghai and avian flu in Guanxi in the past year. The disease has infected 182 and claimed 34 casualties. The World Health Organization called it the largest streptococcus suis epidemic in history. This epidemic underscores the weaknesses in China’s basic public health system, particularly its emergency response. The warning bells ring once again, calling for revolutionizing medical care in rural China.

According to the media in China, most of Sichuan’s infected patients were farmers. Before they fell sick, they were all involved in slaughtering, processing, or consuming infected hogs. The epidemic broke loose because infected pigs were not controlled and destroyed quickly.

Many of the victims ate pork from pigs that they raised and slaughtered. If the farmers knew that the pigs were sick, why did they risk eating it? Some academics say that farmers were foolish and not properly educated in sanitation and science.

But that’s not the whole picture.

Were farmers really unaware of the dangers of eating meat that came from a sick pig? No – their income were just so low that they didn’t have a choice. According to Chinese media, some farmers say that when a 100-pound pig suddenly dies, the farmer’s family couldn’t bare to waste it and throw it away, so they just slaughtered the pig and ate it. Some people were tempted to buy 100 pounds of pork for only 30 yuan, even if the pork could be contaminated. In this way, the sick hogs became the food source for many locals. The chain of illegal backyard slaughter houses and selling of infected pork led to the quick spread of the disease. Local markets lacked disease control, and bureaucrats turned the other way.

The swine disease is a sickness that can be passed from animal to human. With today’s medical technology, the disease shouldn’t have caused so many deaths. But again, the poverty of farmers quickened the spread of the disease. Because the farmers’ incomes were so low, they often delayed in seeing a doctor. At the first sign of infection, the farmers often waited for the symptoms to go away. But when conditions didn’t improve, they couldn’t afford to pay for a hospital visit. The underdevelopment of rural medical and health care caused the decline of disease prevention, emergency care, medical treatment, and basic healthcare provisions. In this heart breaking situation, the sick could not get timely medical care.

As early as June 24, three hospitals in the Sichuan province received 20 cases of an unidentified disease. But the local government, lacking in a standardized medical investigation procedure, treated the disease as simply a “strange” disease. Public health officials at the lower levels did not do a thorough investigation of gathering, analyzing, and reporting disease information.

To make matters worse, public health information could not be effectively communicated. Upper levels of the public health department had difficulty gauging the situation, so it took them a whole month to verify the disease. Lastly, lower levels of the government lack proper response to sudden public health emergencies. They could not handle and manage the situation. This is the main reason why the swine disease could not be controlled effectively, even this late in the process.

The lower you go on the totem pole of the Chinese public health system, the more shortcomings you find. After a high-level national emergency response structure was established, nothing trickled down to real rural levels. Officials did not know how to respond to an infectious disease. Why is this happening? The most direct reason is that local public health departments do not understand their responsibilities in responding to a public health emergency. The monitoring and controlling of emergency responses is frightfully incomplete.

Lower level governments typically haven’t exerted their responsibilities, so in a case of emergency, instead of hurrying to save patients, they hurry to the limelight to save themselves and their jobs. But when it comes time to assign responsibility for what happened, officials find a few lower level workers as scapegoats. Words can’t describe the corruption that has spread in the system.

Additionally, complicating the problem are specialists who wish to change the medical care system and privatize public health services overhauling the system created by the central government.

Preventing infectious disease has many layers of causes, which go much deeper than the healthcare system or medical treatments. Officials on all levels have not placed enough emphasis on rural health care and disease prevention. China’s most urgent need right now, besides saving those who have fallen to the swine disease, is to strengthen public health services.

To Stop Avian Flu, Treat Animals Better

Pacific News Service, Commentary, Rochelle Regodon, Feb 22, 2005

Editor's Note: Cramming thousands of ducks and chickens into unsanitary pens is not only cruel, it provides the perfect breeding ground for deadly viruses.

HONG KONG--The outbreak of bird flu now sweeping through much of Asia was preventable.

Avian influenza in China, Cambodia, Indonesia, Japan, Laos, Malaysia, South Korea, Thailand and Vietnam has brought death to dozens of people, as well as hundreds of millions of ducks and chickens slaughtered in an effort to halt further spread of the disease. The World Health Organization (WHO) and the U.S. Centers for Disease Control predict that this flu is poised to become the next pandemic, with the potential to kill as many as 7 million people. Health officials here in Hong Kong and throughout the world are weighing in on how best to deal with what could become a worldwide disaster.

This virus, in its many forms, can be devastating, but it is also sickeningly predictable. New influenza strains almost always originate in chickens, ducks and pigs living in great numbers close to people in southern China. Typically, flu spreads from ducks to humans, or from ducks to pigs to people. The virus often mutates, becoming more virulent as it jumps from one species to another.

The key to prevention lies in improved animal husbandry and farm hygiene. These animals usually live in crowded, inhumane conditions, crammed together with barely enough space to turn around. These farms are the perfect reservoirs for the spread of disease. (The abysmal factory farms in America are no better, with as many as 10,000 chickens cooped up in a single, large metal shed. But the widespread use of antibiotics in animal feed -- up to 50 percent of all antibiotics produced in the United States are given to farmed animals -- keeps many diseases at bay.)

Shigeru Omi, Western Pacific regional director of WHO, points out that the only way to reduce the threat of bird flu to humans is to change farming practices. "This means a thorough overhaul of animal husbandry practices, and the way animals are raised for food in the region," Omi says. "I believe that anything less than that will only result in further threats to public health." In China, where the deaths of farmed animals from various diseases cause a loss of $2.8 billion a year, the Ministry of Agriculture is trying to do this. The ministry is working to establish disease-free zones in five of China's provinces, largely by teaching farmers how to improve sanitation and living conditions for animals.

But, as they say in America, this is a little like closing the barn door after the horse has escaped. When health and agriculture officials around the world have known for so long how influenza spreads, why has it taken so long for this issue even to be discussed?

People for the Ethical Treatment of Animals advocates a vegetarian diet, for both health and ethical reasons. But the least we can do for ducks, geese, chickens and pigs here in Asia is to provide them with decent, sanitary places to live. Doing right by these animals could have saved many human lives and stopped the fear and death that now permeates the air in so many Asian countries.

What hyperbolic stuff these were...