The Young People's Plague
The difference between avian flu and human flu that should be commanding our rapt attention today is that avian influenza, specifically the H5N1 strain known as bird flu, threatens to become the young people's plague. And it is a growing contender to cause a devastating worldwide pandemic in the next few years.
We are too used to thinking of flu as an annual annoyance that kills only the frail and elderly. But that just isn't the case for H5N1. With a mortality rate of over 50 percent, this bird flu has killed over 110 people, striking the young and able-bodied the hardest. Its victims cluster predominantly among 5-to-30-year-olds, a pattern that has held up in the 34 known to have died from bird flu so far this year.
This vulnerability may stem from the robust and fast-responding immune systems of the young. The victims overreact to the alien virus, triggering a massive immune response called a cytokine storm, turning healthy lungs into a sodden mass of dying tissues congested with blood, toxic fluid, and rampaging inflammatory cells. As air spaces choke off, the body loses oxygen and other organs fail.
Scientists have recently shown that H5N1 has ominous parallels with the devastating 1918 flu pandemic, which also jumped directly to humans from birds and disproportionately attacked the young and the strong. With a pattern highly suggestive of a cytokine storm, death sometimes came within just hours, turning many World War I troop ships into death ships.
Now imagine hundreds of thousands of young people laboring on respirators, or lying alone in corridors and makeshift hospital rooms, too sick to be helped when the supply of beds, equipment, and trained staff run out. Seem like hype? Not to the medical experts who discussed these scenarios during last week's U.S. News Health Summit on emergency preparedness.
This picture puts a face on the U.S. Department of Health and Human Services' projections that, if H5N1 mutates into a readily human-transmissible form, 209,000 to 1.9 million Americans could die. We're talking about our little-leaguers; soccer buddies; schoolmates; someone's aspiring detective, doctor, or engineer. Perhaps your own son or daughter, or your grandchild. One of our most primal human urges is to protect the young, and it may be the very thing we need to tap into if we are to take the pandemic-flu threat seriously.
Close contact. Part of our readiness thinking should be to heed the blunt words of HHS Secretary Michael Leavitt at the summit: Any family or community that fails to prepare for the worst, with the expectation that the federal or state government will come to the rescue, will be "tragically wrong." In a pandemic, the government's medical resources will be stretched thin, and it won't be able to guarantee first-line help to any hometown, local hospital, or college campus. Even the national stockpile of Tamiflu, the antiviral that is the best we have to prevent or lessen the impact of the illness, has its limits. If a college student is hospitalized with a possible H5N1 infection, the feds will provide drugs. But they will not make it available to fend off the virus in the many others who may have come in close contact with the infected student. In the existing federal guidance on H5N1, the young and healthy fall into the lowest-priority group for antiviral drugs and vaccines. Student health centers or other providers had better scrounge up their own stockpiles.
Containing possible outbreaks on college campuses may be all but impossible. Social distancing--avoiding close contact with other people with air kisses instead of smooches, or even by donning masks and gloves--will be tough to enforce. As panelist Georges Benjamin, physician and executive director of the American Public Health Association, said, students "eat after each other; they drink after each other; and they share lots of things." No surprise, then, that prevailing thinking among college administrators is to close dorms and send students home. But what's the trigger point, or the signal for an all-clear?
The threat poses a uniquely difficult challenge. In the best of all scenarios, the virus will lose its fury and leave in its wake a new culture of individual and community preparedness. But we need to get ready now, and not for the best scenario but for the worst.
This story appears in the May 1, 2006 print edition of U.S. News & World Report.