A World of Worry
Disease experts scramble to find out how bird flu infected an Indonesian family
Puzzle. Indeed, much about H5N1 remains a mystery. Scientists have long been puzzled by the fact that the unusually virulent virus, which has killed millions of birds, rarely infects humans. Earlier this year, researchers discovered that H5N1 isn't equipped to infect humans' upper respiratory tract, as colds and the seasonal flu do. Rather, it infects cells deep in the lungs, making it harder to spread.
Still, infectious disease experts are spooked by the fact that the bug has defied all efforts to eradicate it. Rigorous culling of birds and sanitation measures have extinguished past outbreaks of bird flu. "This thing is not going away," says Donald Low, head of microbiology at Mount Sinai Hospital in Toronto, who led efforts to fight the SARS epidemic there in 2003. "This is unprecedented."
The discouraging news comes after a seeming run of good luck. No human cases of H5N1 have been reported in Europe, though the virus spread to birds there over the past six months. And Vietnam, which reported the most human bird flu cases last year, has had considerable success controlling the virus. Last year, it reported 61 cases of bird flu in humans and 19 deaths. This year, it has reported no new cases.
Then came Indonesia. So far this year, 22 people have died of bird flu there, almost half of the cases worldwide. Two of those people died last week in West Java, Indonesian officials reported. It appears there is no link between their deaths and the northern Sumatra cases. Infectious disease experts say the Indonesian government has been less vigilant than other countries in educating local health workers, culling infected poultry, and quickly isolating human cases. In the Sumatra cases, a man who fell ill after he nursed his son refused treatment and fled before he died, increasing the risk that others would be infected. Experts also say that the country's poultry vaccination program may actually help spread the disease because vaccinated birds could harbor the virus and not fall ill.
Vigilance. Scientists expect more such outbreaks. "The hope is that you can get in there and contain it and reduce the risk of letting this virus learn how to become more humanized," says Low. That, he says, is what happened with SARS. But that requires vigilance worldwide and a quick response to contain outbreaks, a daunting task. Late last week, the WHO's assembly voted to launch a global fast-reporting system immediately. But few countries can provide that level of surveillance. The woman who hosted the barbecue was dead and buried before anyone realized that bird flu was raging in the family, and local residents resisted efforts by federal officials to investigate.
All of this hand-wringing about whether or not it's a pandemic is a distraction, says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "We are woefully unprepared." The world lacks a pandemic flu vaccine, hospitals in the United States have enough oxygen to treat patients for only two or three days, and the global community hasn't figured out how people will get food, water, and medical supplies during a pandemic that could disrupt economies for months. A report from the University of Pittsburgh's Center for Biosecurity says it would cost the average hospital $1 million to gear up, not counting buying more ventilators and antiviral drugs. Says Osterholm: "We're nibbling at the edges of the things we need to do."
With Jill Canada
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