Pic: www.brown.edu

With the huge human populations of the present, the risks are even greater. The nearest thing to a real modern instant-killer type of plague was the Spanish flu epidemic, in 1918. It killed 675,000 Americans, and millions of people, worldwide. Even in Australia, my aunt Thelma died of it, leaving my grandmother with two surviving children out of seven. Epidemiology can be a thankless profession, when talking about potential disasters has to compete with the existing disasters. It also has to compete in the public and private arenas for budgets. The reasons for the concern about influenza as a contender for another big pandemic are: It’s highly mutation-prone, Easily spread through airborne and local methods of infection, It can travel the world in 24 hours. It’s specifically targeted for humans. Preparing for an epidemic is like preparing for a massive earthquake. You know it’s going to be rough. You can try and do the best you can, but there are a lot of unpredictable elements. The important thing about preparation is that at least you have something to work with, as distinct from nothing. This New York Times piece is a good indicator of the issues: ““There is a worry that there was a lot more attention to the issue two or three years ago,” said Richard Hamburg, government relations director for Trust for America’s Health, a Washington-based nonprofit health watchdog. “The fact is that it’s still spreading. There are still cases throughout the world. Preparedness is not a one-shot deal. You don’t know if this will hit this year, next year, five years, 10 years from now.”

Federal officials are tracking the flu worldwide, but it is up to cities and states to prepare their own public health plans. So in 2002, when fears of a new pandemic began to escalate, the federal government agreed to send the states billions of dollars to prepare for a pandemic. The health and human services secretary, Michael O. Leavitt, warned states in 2005 that if they expected the federal government to bail them out when a pandemic hit, they would be “tragically wrong.”” Even the support mechanisms aren’t clear, apart from what definitely isn’t going to be done. That’s not a great policy, either, if it means making the unsupported states centers of infection that can affect the rest of the nation. The states have been rated by Trust for America’s Health. New Jersey got 10/10. New York 9/10. More than half of the other states scored 5 or less out of ten. It’s not a matter of just buying vaccines. The number of flu shots available per head of population is an obvious problem. Add to that the fact that flu vaccines go out of date regularly. Existing vaccines may or may not be what’s needed for a whole new, deadly strain of flu. Existing stocks of vaccines are only viable for five years. Added to which, to fully immunize America alone, you’d need 300 million flu shots. Nobody can produce vaccines in that quantity. In the case of a global epidemic other nations would divert to protecting their own people. Influenza spreads a phenomenal speed, even for a disease. The time factor works against large scale immunization. Hence this situation: “Connecticut, New Jersey and New York expect to use two basic methods to keep the flu under control before the vaccine is ready: antiviral drugs and a kind of mass crowd control. The federal government has bought 50 million courses of antiviral drugs that federal officials said could limit the severity of flu infections and possibly serve to protect uninfected people from the disease.

The Department of Health and Human Services has urged states to buy antivirals through a discount program that offers a federal subsidy, cutting the cost of a course of drugs (enough for one person) to $20 from $80, said Dr. William F. Raub, science adviser to Secretary Leavitt. The eventual goal is to have enough antiviral medication to cover at least one-fourth of the population.” If it’s a killer flu epidemic like 1918, the crowds may not be a problem for more than a few days. Ultimately, the flu will be beaten by genetic control. Viruses are all about genes, it’s their weaponry and their weak spot. Until then, if you hear someone outside yelling, “Bring Out Your Dead”, run like hell.