Recently, eight family members in Indonesia contracted bird flu, H5N1. Seven died; one survived. There have been about a half-dozen such clusters worldwide. Preeminent scientific thinking today is that there probably has been some person-to-person transmission, but genetically the virus had not, and might not mutate to cause rapid human-to-human transmission.
Nonetheless, we must prepare for the worst, a Phase 6 pandemic, which could kill more than one million Americans. Mass inoculations probably won?t happen quickly. We most likely will not have enough vaccine to protect everyone against a yet-unknown mutant strain.
There are many ways to effectively deal with a dangerous contagious disease. While bird flu is killing many birds in more than 20 countries within Asia, Africa and Europe, it has not killed one bird, or one person in the United States. As of June 6, worldwide, 225 people were infected, mostly from bird to person, killing 128.
Several years ago, the Canadian provinces managed to contain a potential epidemic of severe acute respiratory syndrome, or SARS. They did this through early detection at points of entry into Canada, special arrangements for isolation of the infected, and usually voluntary quarantining of contacts. The Canadians did not mass vaccinate; no vaccine was available.
President George Bush?s plan to fight bird flu is for state and local governments to fight it with little, if any, additional federal funding. It?s a plan without enough funding for full implementation.
In November 2005, Bush asked for $7.1 billion in emergency funding to fight bird flu, with a fraction for state and local public health programs and infrastructure. In December, Congress passed a $3.8 billion appropriation for bird flu preparedness, with only $350 million earmarked for state and local infrastructure. The Federation of American Scientists responded, “No American cities have hospitals that can handle thousands of patients in the event of a serious outbreak.”
The authors of this article are two former directors of state public health departments in Maryland and New Jersey who faced a similar dilemma in 1976 with a possible looming swine flu pandemic. Fortunately, it never materialized.
Based on what we learned then, we believe our preparedness programs today should concentrate on the following:
» Do not prematurely attempt to mass vaccinate. The vaccine might not work against a particular mutant strain. In states that did, there were significant adverse events, including possible deaths.
» Emphasize close monitoring among wild birds and domestic fowl.
» Demand thorough cooperation between public health departments and all other agencies involved.
» Monitor and share information from international health organizations about the spread and type ofbird flu.
» Initially reserve the vaccine for health care workers and first responders. They are at a greater risk of dying while helping us.
» Prepare for testing of infected persons at points of entry to our country.
» Plan for the capacity to rapidly produce large numbers of kits for rapid diagnosis.
» Understand different state, and federal isolation and quarantine laws and how to immediately implement them.
» Keep the public informed, and create programs to prevent panic.
Dr. John Bartlett, infectious diseases expert at the Johns Hopkins Medical Institutions, says he believes that a czar should be appointed to help develop and coordinate a master response plan, with advice and help from government departments, private groups and volunteers.
Now is the time to strengthen our national, state and local public health systems. Then, if and when, there is a new flu strain for which there is little or no human immunity, we would know how to quickly respond and prevent widespread human disease.
Dr. Neil Solomon was Maryland?s first Secretary of Health and Mental Hygiene. Dr. Joanne E. Finley was the former New Jersey Commissioner of Health. Their e-mails are [email protected] and [email protected].
